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s, and heart failure cases in the United States each year, and it increases the risk of kidney failure and blindness. Clinical guidelines recommend that physicians work with patients to keep blood pressures below 140/90 mmHg, even lower for people with diabetes or kidney disease, and encourage all their patients to make healthy lifestyle changes, such as losing excess weight, becoming physically active, limiting alcoholic beverages, and following a heart-healthy eating plan, including cutting back on salt and other forms of sodium, and not smoking.

ALLHAT researchers reported in 2002 that, overall, diuretics are more beneficial than calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, or alpha blockers as initial treatment to lower blood pressure and to protect against adverse effects of high blood pressure. For patients with diabetes or with mildly elevated fasting glucose--a sign of pre-diabetes--diuretics are at least as effective, and in some cases more beneficial, than the other two classes of medications, according to ALLHAT findings published in June 2005.

In general, diuretics are well tolerated by patients, with few side effects. Sometimes called "water pills," diuretics reduce the amount of fluid in the body by helping the kidneys flush excess water and salt from the body.

The other medications lower blood pressure differently. Calcium channel blockers keep calcium from entering the muscle cells of the heart and blood vessels, causing the blood vessels to relax. ACE inhibitors prevent the formation of a hormone called angiotensin II, which normally causes blood vessels to narrow. Alpha blockers allow blood to pass more easily by reducing nerve impulses to blood vessels. However, ALLHAT found that participants taking alpha blockers had 25 percent more cardiovascular events and were twice as likely to be hospitalized for heart failure as those taking the diuretic. Because of these findings, the alpha blocker arm
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Contact: NHLBI Communications Office
NHLBI_news@nhlbi.nih.gov
301-496-4236
NIH/National Heart, Lung, and Blood Institute
1-Feb-2006

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