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Diuretics Best for High Blood Pressure

Cheaper Drugs Are More Effective at Preventing Stroke, Heart Failure
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WebMD Health News

Dec. 17, 2002 -- When it comes to medications to treat high blood pressure, newer isn't necessarily better. In fact, researchers say that in light of new findings from a landmark study, diuretics should be the top choice for combating high blood pressure.

That is the conclusion reached following a massive clinical trial comparing the effects of newer blood pressure drugs to diuretics, which have been around for a much longer time -- and are much cheaper. Specifically, the diuretic studied -- chlorthalidone -- was substantially better at preventing heart failure and stroke that can occur as a result of high blood pressure.

The main diuretic used today is hydrochlorothiazide, or HCTZ, which has fewer side effects than chlorthalidone, the diuretic used in this study. HCTZ is often combined with other diuretics into one pill.

The results of the study, called ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), appear in the Dec. 18 issue of The Journal of the American Medical Association.

The results will likely have doctors rethinking how they treat high blood pressure, which affects about one in four American adults, and is a major cause of heart disease, stroke, and kidney failure.

There are several different classes of new blood pressure drugs. But they had not been compared directly with the older diuretics -- until now. Diuretics lower blood pressure by increasing urinary output and reducing the body's sodium and water volume.

The trial "answers a question that doctors have been asking for years, and that is, which of the available medications are best at preventing complications of blood pressure?" Jackson Wright Jr., MD, PhD, professor of medicine at Case Western Reserve University and one of the trial's research coordinators, tells WebMD.

Wright says the study is convincing because it's the largest trial that's ever looked at problems that can stem from high blood pressure and because the trial has large numbers of women, older people, blacks, and Hispanics. "It clearly confirms the findings of previous studies and extends them."

Drugs are usually only prescribed for high blood pressure if lifestyle changes, including diet and exercise, fail to solve the problem.

The findings could have major implications for the newer drugs and their manufacturers. The new drugs have taken a significant chunk of the high blood pressure drug market.

According to the researchers, diuretics fell from 56% of prescriptions for high blood pressure in 1982 to 27% in 1992, giving way to the newer drugs. They estimate that sticking with diuretics would have saved more than $3 billion. About 24 million Americans take drugs to lower high blood pressure, costing about $15.5 billion annually. To put it more succinctly: Switching from newer drugs to a diuretic would save between $250 and $650 per patient per year, the researchers say.

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