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Diuretics May Be Best Blood Pressure Treatment

Study: More expensive alternatives don't provide better results

By Mark Huffman
ConsumerAffairs.com

January 30, 2008

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Doctors prescribe plenty of expensive drugs - calcium-channel blockers, alpha-blockers or angiotensin-converting enzyme (ACE) inhibitors – to treat high blood pressure. A new report in the Archives of Internal Medicine suggests diuretics offer a cheaper, and more effective alternative.

Diuretics cause the body to remove excess water that often collects in the blood. The researchers say the more commonly prescribed drugs don't appear to offer advantages in improving clinical outcomes compared with use of diuretics when treating hypertension among individuals with metabolic syndrome.

Patients with hypertension (high blood pressure) and metabolic syndrome are at high risk for the complications of cardiovascular disease, according to background information in the article.

The metabolic syndrome was defined as hypertension plus at least two of the following factors: diabetes or pre-diabetes; a body mass index (BMI) of at least 30; high triglyceride levels; or low levels of high-density lipoprotein ("good" cholesterol).

Because some medications for high blood pressure, including alpha-blockers, ACE inhibitors and calcium channel blockers, have a favorable metabolic profile -- for instance, have more favorable short-term effects on blood glucose or blood cholesterol levels -- they have been advocated over other drugs (beta-blockers and diuretics) for the treatment of patients with metabolic syndrome.

Jackson T. Wright Jr., M.D., Ph.D., of Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, and colleagues analyzed data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

A total of 42,418 participants with hypertension and at least one other risk factor for cardiovascular disease were randomly assigned to take a diuretic, a calcium channel, an alpha-blocker or an ACE inhibitor.

Each drug was used to start treatment and other drugs could be added if necessary to control blood pressure.

Patients were followed for an average of 4.9 years for all drugs except the alpha-blocker; that arm of the trial was discontinued after an average 3.2 years of follow-up in light of increased rates of cardiovascular disease, including a near two-fold increased rates of heart failure, when compared with the diuretic arm. A total of 23,077 ALLHAT participants (54.4 percent) met criteria for metabolic syndrome.

"No differences were noted among the four treatment groups, regardless of race or metabolic syndrome status for the primary end point," the authors write.

Among patients with the metabolic syndrome, the calcium channel blocker, ACE inhibitor and alpha-blocker had higher rates of heart failure compared with the diuretic; the ACE inhibitor and the alpha-blocker also had an increased risk of combined cardiovascular disease.

"These findings fail to provide support for the selection of alpha-blockers, ACE inhibitors, or calcium channel blockers over thiazide-type diuretics to prevent cardiovascular or renal outcomes in patients with metabolic syndrome, despite their more favorable metabolic profiles," the authors conclude.

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