The largest hypertension study ever conducted has found that
the simple "water pill" is preferred to newer, more popular and
expensive drugs and should be the designated choice "for use in starting
treatment for high blood pressure."
But what if you're among the 24 million Americans taking other
types medications to manage hypertension? Should you talk to your doctor of
switching to a diuretic (water pill), whose use has dwindled in recent decades
with the introduction of newer drugs?
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Spero Karas, MD, assistant professor...
"Yes," says the lead researcher of this landmark study,
called ALLHAT for the Antihypertensive and Lipid-Lowering Treatment to Prevent
Heart Attack Trial.
"The bottom line of our study is that diuretics should be
considered as the first step for treating all new cases of hypertension,"
Barry R. Davis, MD, PhD, of the University of Texas School of Public Health,
tells WebMD. "But diuretics should also be part of every
Davis adds that while the study findings recommend using
diuretics to start treatment of high blood pressure, it shouldn't be
interpreted to suggest that only newly diagnosed patients would benefit from
"The way the clinical trail was conducted, 90% of the study
participants had been on some type of medication [before the study], and their
medication was stopped and they were switched to four different drugs in
randomized fashion -- including the diuretic," he says. "And those
taking the diuretics, which are much less expensive, fared as good or
Plus, they don't cause any additional side effects than the
other drugs -- typically increased urination that subsides after several weeks,
and sometimes dizziness, muscle weakness, and cramps. "In rare cases,
someone can't take them because they may be allergic to them," says Davis.
"But for the average patient, they are the better choice. So if you are on
another medication and your blood pressure is not controlled, and another
medication has to be added, as is often the case, it should be a
The results of the eight-year ALLHAT trial, released recently
in the Journal of the American Medical Association, brings new attention
to this old standard in blood pressure treatment, which works by ridding the
body of excess salt and water. The generic diuretic used in the study,
chlorthalidone, was deemed a better choice than two other types of treatments
that can cost as much as 30 times more --- the ACE inhibitors Prinivil or
Zestril and the calcium channel blocker Norvasc. A third medication, the
alpha-blocker Cardura, was dropped from the study some two years ago because it
increased the risk of heart disease and stroke in study participants.
The diuretic was found to be better at lowering systolic blood
pressure -- the top number in a blood pressure reading -- than the newer drugs,
but Norvasc was more effective in reducing diastolic blood pressure, the bottom
number. However, those taking Norvasc had a 38% higher risk of developing heart
failure and a 35% higher chance of being hospitalized for the condition.
Meanwhile, those on the ACE inhibitor had a 15% higher risk of stroke, a 19%
higher risk of developing heart failure, and other increased risks compared
with people taking a diuretic.