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News
USC Cardiology in the Media
Study shows diuretics more effective than newer drugs in stemming heart problems
by Alicia Di Rado
April 15, 2005
A Keck School of Medicine cardiologist has helped bring diuretics back to the forefront as the key, first-line therapy to reduce heart disease in patients with high blood pressure.
The latest results from the Anti-hypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, or ALLHAT-which compared therapies for the prevention of heart disease-were published in the April 6 issue of the Journal of the American Medical Association (JAMA). L. Julian Haywood, professor of medicine in the division of cardiovascular medicine at the Keck School, was one of the paper's co-authors and has served on ALLHAT's steering committee.
ALLHAT is the first large-scale trial-with 33,357 participants, all hypertensive and older than 55-to compare diuretics, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors as initial therapies in a population with large numbers of African-American participants.
High blood pressure, or hypertension, contributes to numerous health problems that hit African Americans especially hard: About 40 percent of African Americans have cardiovascular disease, and each year, cardiovascular disease accounts for 37 percent of the nearly 286,000 African Americans who die.
In the JAMA study, researchers reported that diuretics worked more effectively to prevent heart problems than other newer medications, such as calcium channel blockers and ACE inhibitors, in both African Americans and those of other races.
The study concluded that diuretics are either similar or better than newer drugs in lowering blood pressure and preventing significant complications from high blood pressure. Patients also tolerate diuretics as well or better than newer medicines.
When they compared calcium channel blockers to diuretics, researchers saw a 37 percent higher risk of heart failure among participants taking calcium channel blockers than among those on diuretics.
And when they compared ACE inhibitors to diuretics, they found diuretics were more effective in preventing cardiovascular disease, especially heart failure, for all participants. Diuretics also were significantly more effective than ACE inhibitors in reducing high blood pressure and preventing stroke among African Americans, in particular. Based on this study finding, the authors conclude that as a first-line drug for treating high blood pressure among African Americans, ACE inhibitors are less desirable than alternative medications.
About 65 million Americans, or one in four adults, have high blood pressure. Prevalence worsens with age: More than half of those over age 60 have hypertension. High blood pressure is a risk factor for heart disease and the chief risk factor for heart failure and stroke.
The study's lead author was Jackson T. Wright Jr., professor of medicine at Case Western Reserve University School of Medicine. ALLHAT, an 8-year study that began in 1994, was funded by the National Heart, Lung and Blood Institute.
Jackson T. Wright Jr., J. Kay Dunn, Jeffrey A. Cutler, Barry R. Davis, William C. Cushman, Charles E. Ford, L. Julian Haywood, Frans H. H. Leenen, Karen L. Margolis, Vasilios Papademetriou, Jeffrey L. Probstfield, Paul K. Whelton, Gabriel B. Habib, "Outcomes in Hypertensive Black and Nonblack Patients Treated With Chlorthalidone, Amlodipine, and Lisinopril," Journal of the American Medical Association. April 6, 2005, Vol. 239, No. 13, Pp. 1595-1608.
Original article can be found here:
http://uscnews.usc.edu/hscweekly/detail.php?recordnum=11206
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