New results from the landmark NIH hypertension study will change how patients with high blood pressure are treated.
Currently, most hypertension patients start on an ACE inhibitor, beta-blocker, or calcium channel blocker.
A thiazide diuretic is often added when extra blood pressure control is needed. When I began practicing, diuretics were the mainstream therapy for hypertension. Their use was later reserved for secondary treatment of high blood pressure while the above mentioned drugs were primarily used.
But the 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 are linked with a 38% higher risk of developing heart failure compared to chlorthalidone.
ACE inhibitors 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. Special needs must be kept in mind...ACE inhibitors for diabetes...beta-blockers after heart attack...etc.
We must remain focused on the main problem...only about 30% of hypertension patients currently are adequately controlled.
I like to remind patients how important it is to reach and keep their target blood pressure...usually less than 140/90. Most hypertension patients will need at least two drugs.
If you are a hypertension patient not getting a thiazide diuretic, I highly suggest you talk with your physician.