Diuretics most effective hypertension drug

Results from a five-year trial support this class of drugs as a first-line medication for high blood pressure treatment.

By Susan J. Landers, AMNews staff. Jan. 20, 2003.

Washington -- Heads up! Patients may soon be asking if they should switch their high blood pressure medications to an older, and much cheaper, class of drugs -- diuretics.

Findings from a federal study, published in the Dec. 18, 2002 JAMA, have determined that the medication first introduced in the 1950s is often more effective than newer and more costly drugs at lowering high blood pressure. Those findings are generating a great deal of attention.

The trial was the largest to test diuretics against the newer calcium channel blockers and ACE inhibitors. Beta-blockers were not included. An arm of the trial to test alpha-adrenergic blockers was stopped in March 2000 because of increased cardiovascular problems for those subjects.

While all three classes of drugs tested during the nearly five-year-long trial lowered blood pressure and reduced cardiovascular complications, diuretics were more likely to prevent heart failure and strokes, especially among African-Americans. There was no difference in overall deaths among participants.

Many of the participants were prescribed a second drug to control their blood pressure.

The specific drugs tested in the trial were the diuretic chlorthalidone, the calcium channel blocker amlodipine and the ACE inhibitor lisinopril.

The implications of the findings are enormous. Some 50 million Americans have high blood pressure, increasing their risks for heart attack, heart failure and stroke.