A systematic review of commencing full-dose antihypertensives in newly diagnosed hypertension

Hypertension is the UK’s most common treatable cause of mortality and morbidity, including cardiovascular disease (CVD), renal disease and dementia This systematic review has explored the efficacy and safety of commencing full-dose antihypertensive treatment in individuals with essential hypertension. Method16 randomised controlled trials (RCTs) were eligible for inclusion, with some RCTs assessing more than one treatment. The review assessed commonly used antihypertensive drugs (perindopril 8 mg, ramipril 10 mg, amlodipine 10 mg, losartan 100 mg, irbesartan 300 mg, candesartan 16 mg and candesartan 32 mg) compared to low starting doses or placebo RCTs. Eligible studies included 12 RCTs that compared full vs low doses and 19 RCTs that compared full starting doses vs placebo. The primary outcome was the difference in blood pressure reduction compared to controls (reported or calculated). ResultsUsing full doses compared to low doses led to better BP reduction (overall, 3.9/2.2 mmHg lower achieved BP) without an increase in adverse effects. This notion is supported by the changes achieved with full-dose treatment initiation compared to placebo (average over all studies: 11.4 [4.4]/6.5 [2.9] mmHg). This review indicates that initiating full-dose antihypertensives for essential hypertension may be beneficial and safe. The available data are limited, and further RCTs are required to assess this in specific patient groups to assess safety and efficac. High blood pressure is the leading preventable cause of death and serious illness in the UK. When left untreated, it can lead to heart disease, stroke, kidney problems and dementia. The good news is that high blood pressure is treatable. With proper medication and lifestyle changes, people can significantly reduce their risk of developing serious health problems. We conducted a comprehensive review of the existing research base to determine whether starting high blood pressure patients on full-strength medications from the beginning is more effective and safer than starting with lower doses. We found 16 high-quality studies involving commonly prescribed blood pressure medications, including perindopril, ramipril, amlodipine, losartan and irbesartan. The studies compared full doses versus low starting doses and full doses versus inactive placebo pills. The results showed clear benefits to starting with full-strength medications. When patients began treatment with full doses rather than low doses, their blood pressure dropped. Importantly, starting with full doses did not cause more side effects than beginning with lower doses, suggesting this approach is safe for most patients with essential hypertension (high blood pressure without an underlying cause). These findings suggest that doctors could help patients achieve better blood pressure control more quickly by prescribing full-strength medications from the start, rather than gradually increasing doses over time. However, researchers note that more studies are needed to confirm this approach works safely across different patient populations.

高血压（Hypertension）是英国最常见的可治疗性死亡与致残病因，可引发心血管疾病（cardiovascular disease, CVD）、肾脏疾病及痴呆症。本系统综述（systematic review）探讨了原发性高血压（essential hypertension）患者起始全剂量降压治疗（antihypertensive treatment）的有效性与安全性。方法：共纳入16项符合纳入标准的随机对照试验（randomised controlled trials, RCTs），其中部分RCTs同时评估了多种治疗方案。本综述评估了常用降压药物：培哚普利（perindopril）8mg、雷米普利（ramipril）10mg、氨氯地平（amlodipine）10mg、氯沙坦（losartan）100mg、厄贝沙坦（irbesartan）300mg、坎地沙坦（candesartan）16mg及坎地沙坦（candesartan）32mg，对比低起始剂量或安慰剂（placebo）的RCTs。符合纳入标准的研究包含12项对比全剂量与低剂量的RCTs，以及19项对比全起始剂量与安慰剂的RCTs。本研究的主要结局指标为与对照组相比的血压（blood pressure, BP）降幅差异（已报道或经计算得出）。结果：与低剂量组相比，全剂量组的血压控制效果更优（整体实现的血压降低3.9/2.2 mmHg），且未增加不良反应（adverse effects）发生率。全剂量起始治疗对比安慰剂所带来的血压变化也验证了这一结论（所有研究的平均降幅为11.4[4.4]/6.5[2.9] mmHg）。本综述表明，为原发性高血压患者起始全剂量降压治疗或具有获益性与安全性。但现有数据存在局限性，仍需开展更多RCTs以在特定患者群体中评估该治疗方案的安全性与有效性。高血压是英国最主要的可预防死亡与重症致病病因。若未接受规范治疗，可引发心脏病、脑卒中、肾脏疾病及痴呆症。值得庆幸的是，高血压为可治疗疾病。通过合理用药与生活方式干预，患者可显著降低罹患严重疾病的风险。本团队对现有研究证据开展了全面综述，旨在明确高血压患者起始即服用全剂量药物是否较起始低剂量药物更为有效且安全。本综述共纳入16项高质量研究，涉及临床常用降压药物，包括培哚普利（perindopril）、雷米普利（ramipril）、氨氯地平（amlodipine）、氯沙坦（losartan）及厄贝沙坦（irbesartan）。上述研究分别对比了全剂量与低起始剂量，以及全剂量与无活性安慰剂的治疗效果。研究结果显示，起始全剂量药物治疗具有明确获益。当患者起始采用全剂量而非低剂量治疗时，其血压降幅更为显著。尤为重要的是，起始全剂量治疗并未较低剂量治疗增加不良反应，这表明该方案对绝大多数原发性高血压（无明确继发诱因的高血压）患者是安全的。上述研究结果提示，临床医师可通过为患者起始开具全剂量药物，而非逐步递增剂量，帮助患者更快实现更优的血压控制。但研究人员同时指出，仍需开展更多研究以验证该方案在不同患者群体中的安全性与有效性。