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Diuretics Best for High Blood Pressure

Cheaper Drugs Are More Effective at Preventing Stroke, Heart Failure


The blood pressure study included more than 42,000 participants aged 55 and older. They received either the diuretic chlorthalidone or one of the new blood pressure drugs -- Norvasc (a calcium channel blocker) or Prinivil or Zestril (generic name lisinopril -- an ACE inhibitor). The part of the study that looked at Cardura -- an alpha adrenergic blocker -- was stopped in 2000 because of an increase in heart disease and stroke among study participants.

In the study, the researchers were mainly looking for how well each blood pressure drug prevented a heart attack or death from heart disease. In addition, they looked for other complications of high blood pressure -- including stroke and heart failure.

After five years, researchers found that the diuretic was just as good at preventing heart attack or death as the newer drugs. But the medicines had different effects on blood pressure. The diuretic was better at lowering systolic blood pressure -- the top number -- than the newer drugs, but Norvasc was better at lowering diastolic blood pressure -- the bottom number.

For heart failure, people taking Norvasc had a 38% higher risk of developing heart failure and a 35% higher chance of being hospitalized for the condition. Those on the ACE inhibitor had a 15% higher risk of stroke, a 19% higher risk of developing heart failure, and other increased risks compared with people taking a diuretic.

Even though the overall death rate was about the same in all groups, strokes and heart attacks seriously reduce quality of life. "These have major impacts on people's lives," said Barry R. Davis, MD, PhD, professor of biometry at the University of Texas School of Public Health and the lead investigator on ALLHAT.

"The take-home message is that doctors should begin drug treatment for high blood pressure with a diuretic," said Paul Whelton, MD, MSc, senior vice-president for health sciences at Tulane University, and an ALLHAT regional coordinator. "A great majority of patients can tolerate a diuretic, but, for those who can't, then a calcium channel blocker, an ACE inhibitor, or a beta-blocker [also a new medication that was not tested in this study] may be used to start treatment."

The trial also indicates that most patients require more than one drug to control blood pressure, with a diuretic being a key component of any such combination.

If you are currently taking a calcium channel blocker, an ACE inhibitor, or another high blood pressure drug besides a diuretic, you should certainly continue to take your medication, but you should also talk to your doctor about adding a diuretic or switching to one, says Whelton.

Related Links:

ALLHAT Follow-up:Water Pills Help All With Hypertension WebMD Feature, Jan. 2, 2003.

ALLHAT Follow-up:What To Do: Treat, Don't Tolerate High Blood Pressure WebMD Feature, Jan. 14, 2003.

ALLHAT Follow-up:Monitoring Blood Pressure at Home WebMD Feature, Jan. 17, 2003.


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