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Do Some Blood Pressure Drugs Up Heart Risk?

Study: Calcium Channel Blockers May Not Work as Well in Women as Other Drugs

Twofold Higher Death Risk continued...

  • A diuretic or water pill. The most common water pill is hydrochlorothiazide
  • A beta-blocker. Common brand names include Inderal, Tenormin, Lopressor, and Toprol-XL.
  • An ACE inhibitor. Common brand names include Capoten, Vasotec, Prinivil, Zestril, Lotensin, Monopril, Altace, and Accupril.
  • A calcium channel blocker. This includes drugs such as Norvasc, Cardizem, Calan, and Adalat.

Some of the women took combinations of these drugs.

A recent clinical trial showed that diuretics are the best blood pressure drugs to try first. Among women in the WHI, there was no significant difference in heart deaths between women who took diuretics alone and women who took either beta-blockers or ACE inhibitors. But those who took calcium channel blockers alone had a 55% higher risk of dying from heart disease.

When one blood pressure drug isn't enough, doctors often recommend combination therapy. In the WHI, the women who took a diuretic plus a calcium channel blocker had an 85% higher risk of death from heart disease than women who took a diuretic plus a beta-blocker. For women without diabetes, the risk of death was more than twice as high for those taking a diuretic plus a calcium channel blocker than for those taking a diuretic plus a beta-blocker.

These risks were seen in women with no existing heart disease. Doctors often prescribe calcium channel blockers for people with angina -- heart-related chest pain -- high blood pressure or some types of heart rhythm abnormalities. Wassertheil-Smoller stresses the need for patients to understand why their doctors recommend one drug and not another.

"The bottom line is one needs to consider why your doctor has recommended this particular combination of blood pressure drugs that you are on," she says. "Nowadays the public is very well informed about what therapy they are on. Part of being well informed is to talk with your doctor about the rationale for being on one therapy instead of another."

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