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Generic Meds First Choice For Treating High Blood Pressure

August 20, 2010

Expensive brand-name medications to lower blood pressure are no better at preventing cardiovascular disease than older, generic diuretics, according to new long-term data.

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), led by Paul Whelton, MB, MD, MSc, president and CEO of Loyola University Health System, examined the comparative value of different blood pressure-lowering medications. More than 33,000 patients with high blood pressure were randomly assigned to take either a diuretic (chlorthalidone) or one of two newer drugs, a calcium channel blocker (amlodipine) or an ACE inhibitor (lisinopril).

In 2002, ALLHAT researchers reported that among patients followed for four to eight years, the diuretic was better than the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure and overall cardiovascular disease.
In the new study, researchers followed ALLHAT participants for an additional four to five years after completion of the trial, bringing the total follow-up period to between eight and 13 years. During this longer follow-up period, the differences among the three drugs narrowed — by most measures they were a statistical dead heat.

The diuretic still was superior in two measures, however. Compared with the diuretic group, the ACE inhibitor group had a 20 percent higher death rate from stroke, and the calcium channel blocker group had a 12 percent higher rate of hospitalizations and deaths due to heart failure.

Diuretics, sometimes called “water pills,” are the traditional medication for high blood pressure. They cause kidneys to remove sodium and water from the body, thereby relaxing blood vessel walls. ACE inhibitors such as lisinopril (brand names, Prinivil® and Zestril®) decrease chemicals that tighten blood vessels. Calcium channel blockers such as amlodipine (brand name, Norvasc®) relax blood vessels.

Diuretics cost $25 to $40 per year, while newer brand-name hypertension drugs can cost $300 to $600 per year. Dr. Whelton was quoted as saying that newer, higher-priced drugs are heavily marketed, and diuretics account for only about 30 percent of prescriptions written for high blood pressure.

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