Diuretics work better than newer therapies in treating high blood pressure and reducing risk of heart disease in both black and non-black patients, according to a long-term, multi-center trial of antihypertensive therapies funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. This analysis by race confirms earlier findings on the effectiveness of diuretics and emphasizes that diuretics should be preferred as a first therapy for most patients with high blood pressure.
Findings of the racial analysis of the "Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial," or ALLHAT, will appear in the April 6, 2005, issue of The Journal of the American Medical Association. ALLHAT is the first large scale trial with 33,357 participants to compare diuretics, calcium channel blockers, and ACE inhibitors as initial therapies in a population with a substantial number of black participants.
The study concludes that diuretics are either similar or superior to newer drugs in lowering blood pressure, in tolerability, and in preventing the major complications from high blood pressure. Across both racial subgroups, there was substantially higher risk of heart failure 37 percent among participants taking calcium channel blockers compared with those on diuretics. When compared with ACE inhibitors, diuretics were more effective in preventing cardiovascular disease, especially heart failure, for all participants and significantly more effective in reducing high blood pressure and preventing stroke in blacks. Based on this study finding, the authors conclude that as the initial drug for treating high blood pressure, ACE inhibitors work less well than alternatives in black patients.
Current blood pressure control recommendations are provided in "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure", issued by the NHLBI's National High Blood Pressure Education Program in 2003. The report is available online at www.nhlbi.nih.gov/guidelines/hypertension/index.htm.
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