May 5, 2006

Diuretics Better at Preventing Heart Failure

image of blood pressure being taken

Diuretic medications are more effective than other high blood pressure medications in preventing heart failure, at least in the short term, according to a new data analysis of a study from NIH's National Heart, Lung, and Blood Institute called the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

High blood pressure (or hypertension) is the leading risk factor for heart failure, a condition where the heart is weakened and does not effectively pump blood throughout the body. Many drugs have been developed in recent years to treat the condition. ALLHAT was launched in part to compare the effects of a diuretic (sometimes referred to as a "water pill") with three newer, more costly blood pressure-lowering drugs: a calcium channel blocker, an angiotensin converting enzyme (ACE) inhibitor and an alpha-adrenergic blocker.

Previous reports from ALLHAT have shown that all four of the drugs are effective in lowering blood pressure. The alpha-adrenergic blocker arm of the study was stopped, however, because those on the drug had 25% more cardiovascular problems and were twice as likely to be hospitalized for heart failure as users of the diuretic.

The new analysis was published in the May 9 online edition of Circulation. In the first year of treatment, participants who received ACE- inhibitors or calcium channel blockers were twice as likely to be hospitalized or die from heart failure than those who were taking a diuretic. In later years, the differences between the study groups were reduced; the rate of developing serious heart failure resulting in death or hospitalization was about the same for participants taking ACE- inhibitors or diuretics, while those on calcium channel blockers had a 22% higher risk.

Diuretics are the least costly of these medicines and appear to be the most effective. However, if you're being treated for high blood pressure, do not make any changes without first talking with your doctor. Every drug has multiple effects, and their benefits have to be weighed against their risks to find the best treatment for each person.

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