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    Diuretics Are Best First Choice for African-Americans, Others

    Is Blood Pressure Treatment Color-Blind? continued...

    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.

    Among the new findings reported by Wright and colleagues in the April 6 issue of The Journal of the American Medical Association:

    • African-Americans who took the diuretic achieved better blood pressure control than those who took the other drugs.
    • Diuretics were better than the two newer drugs for reducing the rates of heart failure in African-Americans. Among non-African-Americans, those who took calcium-channel blockers had the highest risk of heart failure.
    • Neither of the two newer drugs was more effective than the diuretic for preventing heart attacks or death from heart disease in African-Americans and non-African-Americans.
    • The findings showed that ACE inhibitors are less effective than other drugs for lowering blood pressure and preventing poor outcomes in African-Americans. African-Americans who took ACE inhibitors had a 40% greater risk of stroke, a 30% greater risk of heart failure, and a 19% greater risk for cardiovascular events than those who took the diuretic.

    "The overall ALLHAT conclusions that thiazide-type diuretics are indicated as the drug of choice for initial therapy of hypertension apply to both blacks and non-black patient populations," the researchers conclude.

    They also recommend calcium-channel blockers over ACE inhibitors as the initial treatment for African-Americans who cannot take a diuretic.

    'Issue Is Settled'

    In an editorial accompanying the new findings, James Neaton, PhD, of the University of Minnesota School of Public Health, agrees that diuretics are the clear first choice for all patients with high blood pressure who can take them, regardless of race.

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