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Diuretics Are Best First Choice for African-Americans, Others

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

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.

Most patients end up needing a combination of several types of blood pressure drugs to adequately control their hypertension, however.

"It is now time to move beyond comparisons of diuretics with other classes of blood pressure-lowering drugs; that issue has been settled," he writes. "Determining how to lower blood pressure to more optimal levels in the most cost-effective manner and in the populations at risk is the new priority."

Wright admits to being frustrated that so few people with high blood pressure who could be benefiting from diuretics are taking the cheap and highly effective drugs.diuretics are taking the cheap and highly effective drugs.

"It is unfortunate that [physicians] still shy away from giving a diuretic at all or from giving diuretics in adequate doses to control blood pressure," he says.

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