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Diuretics are best for treating high blood pressure

Low-dose diuretics are more effective at preventing cardiovascular health problems than any other blood pressure medication, says a study.

health and fitness Updated: May 23, 2003 02:38 IST

Low-dose diuretics are more effective at preventing cardiovascular health problems than any other blood pressure medication in the market, according to a study released on Tuesday.

The finding comes from an analysis of 42 clinical trials involving close to 200,000 people, making it the most comprehensive assessment of high blood pressure drugs to date, and bolstering the credibility of a landmark study published in December which conveyed the same message.

"This analysis provides compelling evidence that low-dose diuretics are the most effective first-line treatment for preventing the occurrence of cardiovascular disease morbidity and mortality," the authors wrote in the study in the Journal of the American Medical Association (JAMA).

In 1993, US guidelines established diuretics and beta blockers as the first-line treatment for patients with uncomplicated hypertension, but diuretic use in the United States declined during the 1990s, while the number of prescriptions for more expensive trade-name drugs increased.

Numerous trials have been conducted since then, evaluating the benefits of the half-dozen hypertension medications on the market, but the evidence has been fragmented, according to the study's authors.

In an effort to synthesize that evidence, researchers from the University of Washington's Cardiovascular Health Research Unit in Seattle reviewed the data from 42 clinical trials published between 1995 and 2002.

They found that the low-dose diuretics were at least as good as, if not better than, the more expensive alternatives -- beta blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs) and alpha blockers -- for blood pressure-related problems.

Specifically, their analysis showed that none of the alternatives were better at preventing heart attack, heart failure, stroke or death from cardiovascular disease than the cheap diuretic.

And in each case, the diuretics -- which increase urine excretion -- were more effective than each of the alternatives in at least one respect.

"If you are on treatment for high blood pressure, and if you are not taking a low-dose diuretic, it is reasonable to ask your physician, 'Why not?'" commented Bruce Psaty, one of the authors and a professor of epidemiology at the University of Washington.

Psaty and his colleagues did not examine why diuretic use declined during the 1990s, but he speculated that the trend was driven in part by aggressive marketing of the trade-name drugs by pharmaceutical companies.

"The other therapies are more heavily marketed and promoted," noted Psaty.

Psaty said his investigation confirmed that an earlier study, which concluded that diuretics were superior to newer drugs, was indeed consistent with the medical record and not a fluke.

That study was sponsored by the National Heart, Lung, and Blood Institute and appeared in JAMA in December. It was widely reported here in part because of the impact on drug sales.

For the purposes of the latest study, hypertension -- or high blood pressure -- was defined as anything above 90 over 140.

First Published: May 21, 2003 03:01 IST