Findings of the analysis by race of the "Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial," or ALLHAT, will appear in the April 6, 2005, issue of The Journal of the American Medical Association. ALLHAT is the first large scale trial--with 33,357 participants--to compare diuretics, calcium channel blockers, and ACE inhibitors as initial therapies in a population with a substantial number of black participants.
The study concludes that diuretics are either similar or superior to newer drugs in lowering blood pressure, in tolerability, and in preventing the major complications from high blood pressure. Across both racial subgroups, there was substantially higher risk of heart failure--37 percent--among participants taking calcium channel blockers compared with those on diuretics. When compared with ACE inhibitors, diuretics were more effective in preventing cardiovascular disease, especially heart failure, for all participants and significantly more effective in reducing high blood pressure and preventing stroke in blacks. Based on this study finding, the authors conclude that as the initial drug for treating high blood pressure, ACE inhibitors work less well than alternatives in black patients.
"This analysis confirms and extends to all races ALLHAT's original conclusion that diuretics are the right first-line therapy for high blood pressure. While some other recent studies have evaluated newer therapies (includin
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NIH/National Heart, Lung, and Blood Institute