Hypertension Hype

Some medical studies offer small but important advances in our understanding of disease. Others just seem to create confusion. Then there are those rare studies, like last week’s report on the best way to start treating high blood pressure, that could change the way doctors practice medicine for years to come. The study, which was sponsored by the National Heart, Lung and Blood Institute (NHLBI), showed that mild diuretics, or “water pills,” are not just the least expensive means of treating most cases of high blood pressure; they are the most effective as well.

This is not the sort of finding that will probably be reversed in a few years by more research. With more than 42,000 participants–including men, women, blacks and whites–the NHLBI investigation is the largest ever conducted in the study of high blood pressure. The goal was to compare some of the newer antihypertension treatments–like ACE inhibitors and calcium channel blockers–with an older group of drugs called thiazide diuretics. Although each of these medications had been shown to lower blood pressure better than a placebo, they had never really been tested against one another. “When the newer drugs came onboard, they had some hypothetical advantages over diuretics,” explains Dr. Jackson Wright, a professor of medicine at Case Western Reserve University in Cleveland, Ohio, who helped lead the study. “But we did not know which drug was best.”

Now we do. The diuretics turned out to be just as effective as ACE inhibitors and calcium channel blockers in treating hypertension, and were associated with fewer complications. That’s good news for patients, since diuretics are cheap: they cost about $25 a year, in contrast to $250 for ACE inhibitors and $500 for calcium channel blockers. Doctors have also learned that they can prescribe diuretics in much smaller doses than they did 20 or 30 years ago, which means the drugs trigger fewer side effects like dizziness.

There are, to be sure, some exceptions. A doctor might favor an ACE inhibitor over a diuretic, for example, when treating a diabetic patient with kidney disease, since ACE inhibitors help prevent renal failure. But all other things being equal, diuretics should be the first-line medical treatment–that is, if eating better and exercising more aren’t enough to bring down your blood pressure on their own.

Treatment of high blood pressure is a huge market for drugmakers, and the new hypertension drugs had been among the most heavily promoted to doctors. If diuretics were more widely used, the U.S. could save billions of dollars in health-care costs. Not every patient will be able to switch, however, and it often takes more than one drug to control blood pressure. In any event, you should never decide on your own to stop taking any hypertension medication. It could lead to a dangerous spike in your blood pressure–and that’s the last thing you need.

For more, click on “ALLHAT study” at www.nhlbi.nih.gov