AIM: Cheaper diuretics as effective for hypertension as costly meds

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In people with high blood pressure as part of metabolic syndrome, a cluster of conditions that increases the risk for heart disease, diuretics offer greater protection against cardiovascular disease, including heart failure, and are at least as effective for lowering blood pressure as newer, more expensive medications, according to a study published in the Jan. 28 issue of the Archives of Internal Medicine.

The Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial (ALLHAT) is sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH).

ALLHAT compares a diuretic (chlorthalidone) with three newer classes of medications to treat high blood pressure: a calcium-channel blocker (amlodipine besylate), an alpha-blocker (doxazosin mesylate), and an angiotensin-converting enzyme (ACE) inhibitor (lisinopril).
The ALLHAT study is a randomized, double-blind trial involving 42,418 participants, ages 55 and older with high blood pressure (140/90 mm Hg or greater) and at least one other risk factor for heart disease. Of those participants, 23,077 had metabolic syndrome with diabetes or pre-diabetes (fasting blood glucose of 100 mg/dL or greater) at the time of enrollment. Approximately 35% of the participants were black.

The findings shows that even among men and women with metabolic syndrome, and for both black and non-black (Caucasians, Hispanics, Asians/Pacific Islanders and American/Alaskan Natives) participants, the less costly diuretics consistently control blood pressure and are equally beneficial in preventing heart attack and coronary heart disease death.

“This new analysis shows that diuretics are better at preventing cardiovascular disease and thus does not support the selection of the newer drugs over diuretics for preventing poor health outcomes related to hypertension or for lowering high blood pressure," said Elizabeth G. Nabel, MD, director of NHLBI.

The findings run counter to current medical practices that favor ACE-inhibitors, alpha-blockers, and calcium channel blockers for treatment of high blood pressure in those with metabolic syndrome. Also, the results provide new evidence to support the use of diuretics for initial blood pressure-lowering therapy in black patients with metabolic syndrome, according to the NIH.

Another ALLHAT paper, reported in the February issue of Diabetes Care, reached similar conclusions when patients with diabetes were excluded.