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Study Clouds Hypertension Drug Debate

Conflicting Studies Point to Need for Combination of Blood Pressure Drugs
By
WebMD Health News

Feb. 12, 2003 -- New research from Australia will no doubt add to the confusion about which high blood pressure drugs work best. The study appears to contradict a large, U.S. government investigation that made headlines late last year by finding that the oldest and cheapest hypertension drugs are superior to newer and more expensive medications.

In the Australian study, older men with high blood pressure who took one of the newer drugs, known as ACE inhibitors, had a better outcome than those treated with traditional diuretics. In the U.S. trial, which compared four different classes of hypertension drugs, diuretics were reported to be more effective for preventing fatal and non-fatal heart attacks than ACE inhibitors, calcium channel blockers, and alpha-adrenergic blockers.

But hypertension experts contacted by WebMD say the studies are not necessarily contradictory. They add that it is becoming increasingly clear that most patients respond best to a combination of drugs, which should usually include a diuretic.

"Unfortunately, most of the media coverage of this issue has come down to 'this drug is better than that one' or 'that drug is better than this one,'" cardiologist Edward D. Frohlich, MD, tells WebMD. "The truth is that 75% to 85% of people require multiple drugs to control their hypertension, and the best treatment varies from patient to patient."

Diuretics were once the only choice for treating hypertension, but their use has declined with the introduction of the newer drugs. More than 24 million Americans take high blood pressure medications, and the costs vary widely -- diuretics cost approximately $25 per year, ACE inhibitors about $250, and calcium channel blockers about $500.

The Australian trial, reported Feb. 13 in TheNew England Journal of Medicine, included 6,083 men and women with high blood pressure over the age of 64 being treated by family practitioners. The patients received either a diuretic or ACE inhibitor to control their blood pressure and were then followed for four years.

At follow-up, both groups had similar declines in blood pressure, but there were slightly fewer heart attacks and deaths among patients on ACE inhibitors. The difference in outcome was most pronounced among elderly men.

In an editorial accompanying the study, Frohlich writes that the apparently contradictory findings from the Australian and U.S. trials might be explained by ethnic differences among the two study populations. Whites made up 95% of the study group in the Australian study, and 35% of the patients taking part in the U.S. study were blacks. Blacks are known to respond better to diuretics than other classes of hypertension drugs.

He says that elderly patients often have medical conditions that influence the choice of blood pressure treatment. Initial treatment for patients with heart failure should include both a diuretic and an ACE inhibitor, Frohlich writes, and those who have had heart attacks seem to do best with an ACE inhibitor and another class of drug known as beta blockers.

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