Issue 137 Item 1 ALLHAT NIH Hypertension Study Will Change Treatments for Hypert

Surprising results from the ALLHAT study are shaking things up. Currently, most hypertension patients start on an ACE inhibitor, beta-blocker, or calcium channel blocker. Then a thiazide diuretic is often added when extra blood pressure control is needed.
But the surprising results from the huge ALLHAT study are now shaking things up.
Thiazide diuretics (chlorthalidone) are at least as effective as ACE inhibitors and calcium channel blockers for preventing heart attacks and decreasing heart disease-related death. Thiazides are actually MORE effective for preventing heart failure and stroke.
Calcium channel blockers (amlodipine) are linked with a 38% higher risk of developing heart failure compared to chlorthalidone. ACE inhibitors (lisinopril) surprisingly have a 15% higher risk of stroke, 19% higher risk of heart failure, and 11% higher risk of angina compared to chlorthalidone.
Many experts now say to start with a thiazide FIRST…add an ACE inhibitor, calcium channel blocker, or beta-blocker SECOND for most patients. Keep special needs in mind…ACE inhibitors for diabetes…beta-blockers after heart attack…etc.
Focus on the main problem where only about a third of hypertension patients currently are adequately controlled. Tell patients how important it is to reach and keep their target blood pressure…usually less than 140/90 and 125/80 for those with diabetes. Explain that most hypertension patients need at least two drugs.
If you have hypertension patients not getting a thiazide diuretic, suggest they talk with their physician.
For More Information See last weeks item:
Diuretics Best at Lowering Coronary Risk in Hypertensive Patients Click Here
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288(23):2981-97.

ALLHAT: diuretic the best bet as a first step in hypertension. Heartwire December 17, 2002, available at ww.theheart.org