Diuretics Best for High Blood Pressure

[Guest guest]

Diuretics Best for High Blood Pressure

By Gardner

HealthDay Reporter

TUESDAY, April 5 (HealthDay News) -- Diuretics work better than other drugs

at lowering high blood pressure and reducing the risk of heart disease, so

they

should be a first-line treatment for hypertension, new research suggests.

About 65 million Americans, or one in four adults, have high blood pressure.

It is one of the leading risk factors for heart disease and the leading risk

factor for

heart failure

and

stroke.

Studies have long shown that blacks are at especially high risk for

hypertension, 0but until now it's remained unclear whether drugs that work

well in white

patients will perform just as effectively in blacks.

However, this major new study suggests that, " in both blacks and non-blacks,

diuretics are essentially unsurpassed. This is very clear, " said Dr.

T. Jr., lead author of the Antihypertensive and Lipid-Lowering

Treatment to Prevent Heart Attack Trial (ALLHAT).

" Diuretics should be included in the regimen of the vast majority of

hypertensives, and especially black hypertensives, " he added.

Results of the trial, which was sponsored by the National Heart, Lung, and

Blood Institute, appear in the April 6 issue of the Journal of the American

Medical

Association.

These new results confirm previous ALLHAT findings suggesting that diuretics

are at least as effective as other drugs, such as

beta blockers,

ACE inhibitors

or

calcium channel blockers,

in preventing coronary heart disease; that they are more effective in

preventing heart failure; and more effective than beta blockers and ACE

inhibitors

in preventing stroke.

" Diuretics have been around for over half a century, and they have been

shown in multiple previous studies to prevent the complications of high

blood pressure, "

said.

Nevertheless, there had been a shift in recent years to newer agents such as

ACE inhibitors and calcium channel blockers because they seemed to have less

of an effect on blood sugar and blood

cholesterol

than diuretics, explained.

And, until now, experts had not known with certainty whether the superiority

of diuretics applied to all races.

" In hypertension, there's been an ongoing debate for years about whether or

not some therapies work better in blacks than whites, " said D. Neaton,

co-author of an accompanying editorial and a professor of biostatistics at

the University of Minnesota School of Public Health. " This is probably the

first

study that had enough patients -- both blacks and whites -- that could

definitively compare different classes of drugs. This is the largest, most

powerful

subgrouping analysis that's been carried out so far. "

For this study, 33,357 participants, about 35 percent of whom were black,

were randomly assigned to assigned to receive either a calcium channel

blocker,

an ACE inhibitor or a thiazide-type diuretic.

Participants taking calcium channel blockers had a 37 percent higher risk of

heart failure compared to those taking diuretics. Diuretics were more

effective

in preventing cardiovascular disease (especially heart failure) than ACE

inhibitors, among all participants. That reduction in high blood pressure

and

prevention

of stroke was even more pronounced in blacks, the researchers note.

" In blacks, it is very clear that the difference in effect is magnified such

that not only is there a reduced benefit in terms of preventing heart

failure,

but also reduced benefits in lowering blood pressure, preventing stroke and

preventing essentially all cardiovascular outcomes, " said.

" It indicates in our mind that the first-line treatment should be diuretics,

or at least the second drug. That's the sensible take-home message from

this, "

Neaton said.

Another expert agreed.

" The ALLHAT study is very powerful because it enrolled over 33,000 patients

and the follow-up was multi-year, " said Dr. A. , chairman of

the department of medicine at Lenox Hill Hospital in New York City. " It

confirms that, despite all the concerns that people continue to raise about

the

efficacy and safety of using diuretics as first-line therapy, once again we

have further proof that diuretics should be the first-line therapy in

patients

with high blood pressure. "

SOURCES: T. Jr., M.D., Ph.D., professor, medicine, Case

Western Reserve University, Cleveland; D. Neaton, Ph.D., professor,

biostatistics,

School of Public Health, University of Minnesota, Minneapolis; A.

, M.D, Ph.D., chairman, department of medicine, Lenox Hill Hospital,

New

York City; April 6, 2005, Journal of the American Medical Association