Diuretics work better than newer therapies in treating high blood pressure and reducing risk of heart disease in both black and non-black patients, according to a long-term, multi-center trial of antihypertensive therapies funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health. This analysis by race confirms earlier findings on the effectiveness of diuretics and emphasizes that diuretics should be preferred as a first therapy for most patients with high blood pressure.

Findings of the racial analysis 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 (including drug combinations), the weight of evidence, particularly in this multi-racial study, supports the diuretic recommendation,” said Dr. Jeffrey Cutler, NHLBI Senior Analyst and study co-author.

High blood pressure affects about 65 million Americans, or one in four adults, and its prevalence increases with age — more than half of those over age 60 have hypertension. High blood pressure is a risk factor for heart disease and the chief risk factor for heart failure and stroke.

To arrange an interview with Dr. Cutler, contact the NHLBI Communications Office at 301-496-4236 or email nhlbi_news@nhlbi.nih.gov. To arrange an interview with study author Jackson Wright, M.D., of Case Western Reserve University, please call George Stamatis, Director, Public Relations, 216-368-3635.

The multi-center ALLHAT study is conducted under a contract with the University of Texas-Houston Health Science Center; Dr. Barry Davis is the Principal Investigator.

Current blood pressure control recommendations are provided in "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure", issued by the NHLBI's National High Blood Pressure Education Program in 2003. The report is available online at www.nhlbi.nih.gov/guidelines/hypertension/index.htm.

NHLBI is part of the National Institutes of Health (NIH), the Federal Government's primary agency for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services. NHLBI press releases and other materials including information about high blood pressure and heart disease, are available online at www.nhlbi.nih.gov.