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Study Clouds Hypertension Drug Debate

Conflicting Studies Point to Need for Combination of Blood Pressure Drugs


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.

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 drugs.

"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."

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