First-Line Hypertension Therapy: Impact of Age and Ethnicity in Primary Care

Current UK guidelines recommend first-line antihypertensive treatments based on age and ethnicity, but their effectiveness in routine care is unclear. An observational study of over 176,000 new antihypertensive users found that calcium channel blockers (CCB) and ACE inhibitors/angiotensin receptor blockers (ACEI/ARB) produced similar reductions in systolic blood pressure in non-black patients without diabetes, regardless of being younger or older than 55. In black patients without diabetes, CCB showed numerically greater blood pressure reductions than ACEI/ARB, but confidence intervals overlapped. Notably, CCB was associated with greater reductions only in patients aged 75 and older. These findings suggest that current age- and ethnicity-based treatment algorithms may not lead to superior blood pressure control, and individualized factors might better guide drug choice.