More evidence of diuretics working better than newer medicines
for high blood pressure
Case/UHC/VA’s Jackson Wright, M.D., Ph.D.,
lead author
April 13, 2005 | For more information: George
Stamatis 216-368-3635
Diuretics work better than newer therapies in treating high blood pressure
and reducing risk of heart disease in both black and non-black patients,
and diuretics were significantly more effective than a class of drugs
called ACE inhibitors in reducing high blood pressure and preventing
stroke in blacks.
The findings are from an analysis of data written
by Jackson Wright, M.D., Ph.D., professor of medicine
at Case Western Reserve University School of Medicine,
University Hospitals of Cleveland and the Cleveland
Louis Stokes Department of Veterans Affairs Medical
Center, and colleagues. The data is from the "Antihypertensive
and Lipid-Lowering Treatment to Prevent Heart Attack
Trial," or ALLHAT. The report appears in the
April 6 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.
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.
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,
blacks and non-blacks, 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.
High blood pressure affects about 65 million Americans,
or one in four adults, and its prevalence increases
with age. More than half of those over age 60 have
hypertension. High blood pressure is a risk factor
for heart disease and the chief risk factor for
heart failure and stroke.
The population of blacks with hypertension has
the highest rate of illness and death from hypertension
of any population group in the United States and
is among the highest in the world. Death related
to hypertension and the risk of end-stage renal
disease, coronary heart disease, heart failure,
and stroke are increased in the black compared
with the white population in the United States.
There is little cardiovascular outcome data for
blacks with hypertension treated with the common
therapies of angiotensin-converting enzyme (ACE)
inhibitors or calcium channel blockers (CCBs).
The study was funded by the National Heart, Lung, and Blood Institute
(NHLBI) of the National Institutes of Health. The multi-center ALLHAT
study is conducted under a contract with the University of Texas Health
Science Center at Houston.
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 http//www.nhlbi.nih.gov/guidelines/hypertension/index.htm
NHLBI is part of the National Institutes of Health
(NIH), the Federal Government's primary agency
for biomedical and behavioral research. NIH is
a component of the U.S. Department of Health
and Human Services.
JAMA editorial: Diuretics are color blind
In an accompanying editorial,
James D. Neaton, Ph.D., of the University of Minnesota,
Minneapolis, and Lewis H. Kuller, M.D., of the University of Pittsburgh,
discuss the findings by Wright et al.
“After many years of research, the ALLHAT study
has shown that diuretic therapy is highly efficacious
in reducing the risk of CVD among both blacks and
nonblacks. It is notable that with respect to the
black population, ALLHAT had more events than most
trials had participants. It is now time to move beyond
comparisons of diuretics with other classes of BP-lowering
drugs-that issue has been settled. Determining how
to lower BP to more optimal levels (e.g., 120/80
mm Hg) in the cost cost-effective manner and in the
populations at risk is the new priority.”
“More research is needed on nutritional hygienic
approaches, such as those studied in [other] trials,
to prevent hypertension and to supplement antihypertensive
drugs. Also, it is important to continually recognize
that reducing the risk of vascular disease (especially
CHD) involves control of multiple risk factors to
achieve maximum success. The findings of this important
study have provided many ideas for the design of
the next generation of trials-the children of ALLHAT,” they
write.
About Case Western Reserve University
Case is among the nation's leading research institutions. Founded in 1826
and shaped by the unique merger of the Case Institute of Technology and Western
Reserve University, Case is distinguished by its strengths in education, research,
service, and experiential learning. Located in Cleveland, Case offers nationally
recognized programs in the Arts and Sciences, Dental Medicine, Engineering,
Law, Management, Medicine, Nursing, and Social Work. http://www.case.edu.
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