Study Clouds Hypertension Drug Debate
Conflicting Studies Point to Need for Combination of Blood Pressure Drugs
WebMD News Archive
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
American Heart Association hypertension expert Daniel W. Jones,
MD, agrees that the vast majority of patients need a combination of treatments
to control their high blood pressure. He says the findings from the U.S. trial,
known as the ALLHAT study, confirm that diuretics work as well as the newer
"It turns out that the new drugs are different, but they
are not necessarily better than the diuretics," he says. "But it is not
so important to argue about what is the best single drug because most patients
will do best with a combination of drugs."
Hypertension expert Michael A. Weber, MD, agrees but says the
ALLHAT study was misleading because patients were treated with clinically
inappropriate drug combinations. Each of the 42,000 patients in the U.S. trial
was initially treated with one drug -- a diuretic, ACE inhibitor, calcium
channel blocker or alpha-adrenergic blocker. Two-thirds of the patients were
later prescribed a beta-blocker as well because they did not respond well
enough to the single-drug regimen.
Weber, who is professor of medicine at the State University of
New York, says while patients may be confused by the new studies, doctors
probably will not be.
"Most practicing clinicians will look at ALLHAT and the
Australian study and say, 'I had it right all along,'" he says. "They
already know that most patients respond best to a combination of drugs, and
that is what they are prescribing. In this instance, practicing physicians are
way ahead of the researchers."