Study Clouds Hypertension Drug Debate
Conflicting Studies Point to Need for Combination of Blood Pressure Drugs
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."