Diuretics best initial therapy for both black and nonblack patients in treating high blood pressure

03/31/05

Thiazide-type diuretics remain the drugs of choice for initial therapy of high blood pressure in both black and nonblack patients, according to a study in the April 6 issue of JAMA.

Cardiovascular disease (CVD) has become the leading cause of illness and death worldwide, and elevated blood pressure (BP) is a leading contributor to this phenomenon, according to background information in the article. 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 (ESRD), coronary heart disease (CHD), heart failure (HF), 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).

Jackson T. Wright, Jr., M.D., Ph.D., of Case Western Reserve University, Cleveland, and colleagues analyzed data from a subgroup of ALLHAT, a randomized, double-blind, clinical trial which compared high blood pressure medications. The researchers conducted this analysis to determine whether an ACE inhibitor or CCB is superior to a thiazide-type diuretic in reducing CVD incidence in racial subgroups. ALLHAT was conducted between February 1994 and March 2002 in 33,357 hypertensive U.S. and Canadian patients aged 55 years or older (35 percent black) with at least 1 other cardiovascular risk factor.

Participants took either a CCB (amlodipine), ACE inhibitor (lisinopril), or a thiazide-type diuretic (chlorthalidone). Other medications were added to achieve goal blood pressures less than 140/90 mm Hg.

The researchers found: "In both racial subgroups as in the whole cohort, neither the ACE inhibitor nor the CCB was more effective than the thiazide-type diuretic in preventing the primary outcome of myocardial infarction or fatal CHD or any other major cardiovascular or renal outcome, and diuretic-based treatment was superior to ACE inhibitors and CCBs in reducing HF incidence."

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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