Less-expensive diuretics found superior in treatment of hypertension

A major clinical trial of blood pressure medications has concluded that an inexpensive diuretic (water pill) is more effective in treating high blood pressure and preventing cardiovascular disease than newer more expensive medications.

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), conducted from February 1994 though March 2002, compared the drugs for use in starting treatment for high blood pressure.

“The preferred drug is the diuretic for three reasons. It provides better control of hypertension; it reduces complications from hypertension–particularly heart failure– more effectively; and it is 10 to 20 times less expensive than the other drugs used in the trial,” said Curt Furberg, M.D., Ph.D., of Wake Forest University Baptist Medical Center, chairman of the study’s steering committee.

ALLHAT is the largest study ever to compare different types of hypertension drugs. It included more than 33,000 participants age 55 years or older at 623 clinical sites in North America. All the patients had hypertension and at least one other coronary heart disease risk factor. Approximately 50 percent of the participants were women and 35 percent were African-American.

“The bottom line is ALLHAT has shown that it matters which drug you use to control hypertension,” said Furberg.

Participants were randomly assigned to receive the diuretic chlorthalidone, amlodipine (a calcium channel blocker sold under the name Norvasc) or lisinopril, (an angiotensin-converting enzyme (ACE) inhibitor sold under the names Prinivil and Zestril.)

In 2000, another drug used in the trial, doxazosin (an alpha-blocker sold under the name Cardura) was pulled from the trial because it was determined early in ALLHAT that it was not as effective as the less expensive diuretic medication.

The study does not recommend that patients stop taking their medication if they are using a drug other than a diuretic. However they are encouraged to speak with their physicians about adding or switching to a diuretic for their treatment.

ALLHAT’s findings indicate that most patients will need more than one drug to adequately control their blood pressure and one of the drugs should be a diuretic. The National Heart, Lung and Blood Institute, part of the National Institutes of Health, supported the study.

Contact: Jim Steele, jsteele@wfubmc.edu, Jonnie Rohrer, ´jrohrer@wfubmc.edu, Karen Richardson, krchrdsn@wfubmc.edu or Barbara Hahn, bhahn@wfubmc.edu, 716-4587.