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Diuretics Still Best Treatment for High Blood Pressure

Medical researchers reported the findings of a study at the annual meeting of the American Heart Association this week.   They reported that the thiazide-type diuretic chlorthalidone outshone three other treatments — a calcium channel blocker, an ACE inhibitor and an alpha-receptor blocker — in most areas.  This was especially effective in lowering the incidence of stroke and heart failure. 

An estimated 80 million American adults have one or more types of cardiovascular disease according to the American Association for Critical Illness Insurance.  Some 785,000 will have a new coronary attack this year according to the industry trade group. 

The findings the medical experts note are largely unchanged.  They note that the main message is that treating hypertension [high blood pressure] is very necessary and that treating hypertension with chlorthalidone resulted in a significant reduction in heart failure and stroke. 

The original trial, begun in 1994, involved more than 42,000 patients with hypertension and at least one other risk factor for cardiovascular disease. The participants were randomly assigned to take one of the following anti-hypertensive drugs: chlorthalidone (the diuretic), amlodipine besylate (the calcium channel blocker), doxazosin mesylate (the alpha blocker) or lisinopril (an ACE inhibitor). 

The five-year follow-up, which ended in 2002, was intended to see if new differences emerged with long-term use of the medications, especially regarding coronary heart disease, total mortality, heart failure and aggregate cardiovascular disease. 

This is the largest hypertension trial to date, one researcher noted.  Earlier results had also found that diuretics were as good or better than other blood pressure-lowering drugs for treating hypertension in patients with metabolic syndrome (a collection of factors that put people at risk of heart disease), especially black patients.

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