Older Hypertension Medications Best

Several Studies Show Diuretics to Be Single Best Hypertension Medication

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May 20, 2003 -- Another major study has found that the oldest and cheapest hypertension medications work better than newer and pricier hypertension medications. In a review of more than 40 trials involving almost 200,000 people, low-dose diuretics consistently performed as well as or better than other hypertension medications.

Study authors say the findings confirm that diuretics should be considered the first choice of treatment for preventing complications of high blood pressure, including heart attack, heart failure, and stroke. The study comes less than a week after a government panel made a similar recommendation but also stated that most people will need two or even three different medications to control their hypertension.

"I believe high blood pressure patients should be started on diuretics, and, if they aren't on them, they should be switched," lead researcher Bruce M. Psaty, MD, PhD, tells WebMD. "I think patients need to be asking their doctors why they aren't on the most effective drugs, which also happen to be the least expensive."

Some 50 million Americans have high blood pressure, but only about a third know they have it. About 15% of people with high blood pressure are on no treatment, more than 25% are using inadequate treatment, and less than a third are on adequate hypertension medications. It is estimated that 25% of adults have high blood pressure.

In their study, published in the May 21 issue of TheJournal of the American Medical Association, Psaty and colleagues from the University of Washington in Seattle compared data from 42 clinical trials using a unique system of analysis developed at the institution. The researchers were able to compare cardiovascular outcomes among people taking all the major hypertension medications -- diuretics, ACE inhibitors, beta-blockers, calcium channel blockers, angiotensin receptor blockers, and alpha-blockers.

None of the newer treatment classes were significantly better than low-dose diuretics for preventing illness or other complications.

Beta-blockers have been widely considered to be a first-line high blood pressure treatment in the past, but they were found to be less effective than diuretics for all measured cardiovascular outcomes.

"High blood pressure has no symptoms, so the purpose of treating it is to prevent complications like heart attack and heart failure," Psaty says. "It is important to use the drug that is most effective for this purpose. But a month's supply of low-dose diuretics cost less than a cup of Starbuck's coffee, so there is not a lot of incentive to market these drugs."

A year's supply of diuretics averages $25. The other classes of hypertension medications are much higher.

American Heart Association spokesman Daniel W. Jones, MD, agrees that low-dose diuretics are the right choice for the vast majority of patients starting treatment. But he adds that half or more will need a combination of drugs to control their high blood pressure. The widely reported ALLHAT study, published late last year, found diuretics to be the most effective single hypertension medication available. But two-thirds of the 42,000 patients in that trial ended up on combination therapy including one of the newer drug classes.

"For most patients with uncomplicated hypertension, diuretics are a good place to begin," says Jones, who is with the University of Mississippi Medical Center department of hypertension. "The recent evidence from ALLHAT and the [panel recommendation] should make that very clear, and they should very definitely influence clinical practice."

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SOURCES: The Journal of the American Medical Association, May 21, 2003. Bruce M. Psaty, MD, PhD, professor of medicine and epidemiology, University of Washington, Seattle. Daniel W. Jones, American Heart Association blood pressure spokesman and professor of medicine, University of Mississippi Medical Center.
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