Diuretics Best BP Therapy for Blacks - Study

NEW YORK (Reuters Health) - New data fail to support the idea that newer drugs have advantages over diuretic "water pills" for people with high blood pressure (BP), whether or not they have the "metabolic syndrome" -- a cluster of conditions that include obesity, high triglycerides, and insulin resistance as well as hypertension.

The findings come from a large trial called ALLHAT, which compared different types of blood pressure treatments.

"The findings are especially true in African-American hypertensives," ALLHAT researcher Dr. Jackson T. Wright, from Case Western Reserve University School of Medicine in Cleveland, told Reuters Health. He presented the data this past weekend at the International Society on Hypertension in Blacks in San Juan, Puerto Rico.

The ALLHAT group analyzed rates of cardiovascular and kidney complications among more than 18,100 hypertensive patients with the metabolic syndrome, of whom 5,763 were African American, and 11,180 without the metabolic syndrome, of whom 4,277 were African American.

As part of ALLHAT, these individuals were randomly assigned to a diuretic (chlorthalidone), a calcium channel blocker (amlodipine) or an ACE inhibitor (lisinopril).

After nearly 5 years of treatment, "neither the calcium channel blocker nor the ACE inhibitor was superior to the diuretic in preventing any cardiovascular outcome in patients with and without the metabolic syndrome," Wright said.

"In fact, the diuretic was more effective than the ACE inhibitor and the calcium blocker in preventing heart failure and also more effective than the ACE inhibitor in preventing stroke in African Americans with the metabolic syndrome," he said.

"Diuretic therapy remains preferred over ACE inhibitors or calcium channel blockers, as the initial antihypertensive medication, even in the presence of metabolic syndrome in African-American hypertensives," Wright said in a statement.