|ALLHAT Study Findings for Racial
Sub-groups Show Diuretics Work Better than Newer Medicines
for High Blood Pressure
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
“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
To arrange an interview with Dr. Cutler, contact the
NHLBI Communications Office at 301-496-4236 or email
firstname.lastname@example.org. To arrange an interview with
study author Jackson Wright, M.D., of Case Western Reserve
University, please call George Stamatis, Director, Public
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.