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Water Pill Works Best for High Blood Pressure

Diuretics Are Best First Choice for African-Americans, Others
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WebMD Health News

April 5, 2005 -- African-Americans are roughly three times as likely as whites to die of illnesses caused by high blood pressure.

Their increased risk is so great that what defines good blood pressure control is now lower for African-Americansgood blood pressure control is now lower for African-Americans than for whites, but new research shows that, in this group, water pills remain the drug of choice for the initial treatment of high blood pressure.

Using data from a landmark high blood pressure study, researchers showed that the oldest and cheapest blood pressure medications work betterlandmark high blood pressure study, researchers showed that the oldest and cheapest blood pressure medications work better as the initial treatment of high blood pressure, in both African-Americans and other races, than newer, more expensive drugs.

The findings show that thiazide-type diuretics, known as water pills, which cost just pennies a pill, are a better choice for the initial treatment of high blood pressure than the newer drugs, known as ACE inhibitors and calcium-channel blockers.

Is Blood Pressure Treatment Color-Blind?

Though nearly one in three American adults has high blood pressure,one in three American adults has high blood pressure, the figure is closer to one in two for African-Americans.

Because of this, the American Heart Association and other health groups recommend more aggressive blood pressure treatment for African-Americans than for other racial groups. The normal goal of treatment is to reduce blood pressure to below 140/90. But the goal for African-Americans is now 130/80.

In the newly published study, researchers analyzed data from a subgroup of participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Their goal was to look at the risk of heart disease and death from heart disease in African-Americans with high blood pressure taking one of the three commonly prescribed medications.

When first published in 2002, ALLHAT challenged the pervasive thinking that newer blood pressure drugs worked better to treat high blood pressure and prevent some forms of heart disease than water pills, which have been used to treat high blood pressure for many decades. The ALLHAT study showed that a water pill worked better.

ALLHAT researcher Jackson T. Wright Jr., MD, PhD, says the trial has not affected clinical practice to the extent that he had hoped.

"The message has not really gotten out," he says. "There has been a slight increase in diuretic use but not to the extent that one would anticipate from the data that are now available."

Participants in the ALLHAT study, conducted between 1994 and 2002, took one of three drugs to lower their blood pressure, a leading cause of heart disease. They were given one of three commonly prescribed blood pressure medications: the diuretic Hygroton, the ACE inhibitor lisinopril, or the calcium-channel blocker Norvasc.

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