Diabetes In Control. A free weekly diabetes newsletter for Medical Professionals. News and information for Medical Professionals.
New data fails to support preference for other antihypertensives over diuretics.
New data from ALLHAT (Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial) fail to support a preference for either angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers over diuretics in nondiabetic hypertensive patients with or without the metabolic syndrome.
ALLHAT researcher Dr. Jackson T. Wright, from Case Western Reserve University School of Medicine in Cleveland stated that, "The findings are especially true in African-American hypertensives.".
The ALLHAT group analyzed the cardiovascular and renal complications of more than 18,100 hypertensive patients with the metabolic syndrome, of whom 5,763 were African American, and 11,180 without the metabolic syndrome, of whom 4,277 were African American. As part of ALLHAT, these individuals were randomly assigned to a diuretic (chlorthalidone), a calcium channel blocker (amlodipine) or an ACE inhibitor (lisinopril).
After 4.9 years of treatment, "neither the calcium channel blocker nor the ACE inhibitor was superior to the diuretic in preventing any cardiovascular outcome in patients with and without the metabolic syndrome," Dr. Wright said.
"In fact, the diuretic was more effective than the ACE inhibitor and the calcium blocker in preventing heart failure and also more effective than the ACE inhibitor in preventing stroke in African-Americans with the metabolic syndrome," he said.
In the ACE inhibitor-diuretic comparison, "which is the one of greatest interest," Dr. Wright noted, there was a 37% higher risk of stroke, a 49% higher risk of heart failure, a 23% higher risk of combined cardiovascular events and a 70% higher risk of ESRD in African-Americans with the metabolic syndrome randomized to the ACE inhibitor.
"In non-blacks with the metabolic syndrome randomized to the ACE inhibitor, there was a 20% higher risk of heart failure and a 10% higher risk of combined cardiovascular events," he reported.
In the calcium channel blocker-diuretic comparison, there was "a significant 13% higher risk of combined cardiovascular disease events," in African-Americans with the metabolic syndrome randomized to the calcium blocker, Dr. Wright also reported.
"Diuretic therapy remains preferred over ACE inhibitors or calcium channel blockers, as the initial antihypertensive medication, even in the presence of metabolic syndrome in African-American hypertensives," Dr. Wright said in a statement.
He presented the data this past weekend at the International Society on Hypertension in Blacks in San Juan, Puerto Rico.
Learn about the Steps To Health, a program to increase physical activity that has gone through 8 years of clinical studies to show its effectiveness.
https://www.steps-to-health.org
=============================
WarmFeet Kit can help with painful neuropathy and wound healing.
To Find our more:
https://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=2007
The 10,000 STEP STUDY:
"The Results". A simple answer to a difficult problem.
https://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=2001