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Newer Meds Better Than Diuretics For High Blood Pressure?

April 30, 2011

An analysis of fifteen past studies has revealed that when it comes to treating high blood pressure, many people may be more likely to use certain types of medications than others, researchers say.

Researchers found that, on average, people were less likely to remain on prescription diuretics than on relatively newer medications.

They found that patients were most likely to stick with angiotensin II receptor blockers, or ARBs — a group of drugs that includes names like valsartan (Diovan), candesartan (Atacand) and losartan (Cozaar).

ACE inhibitors were used secondly most often used. These include ramipril (Altace), lisinopril (Prinivel, Zestril) and captopril (Capoten).

Diuretic users were about twice as likely to stop taking their medication as ARB users, researchers reported in the medical journal Circulation.

Dr. Ian M. Kronish of Mount Sinai School of Medicine in New York, leader of the new research, said that various classes of blood pressure medicines differ in how they work and in their side effects.

However, the research findings do not necessarily mean that a person will stick with an ARB longer, or that those drugs should be a first choice for treating high blood pressure, said Dr. Niteesh K. Choudhry, of Brigham and Women’s Hospital and Harvard Medical School in Boston, who was not involved in the study.

In an interview with Reuters, Choudhry said national guidelines recommend diuretics as a “first-line” medication for high blood pressure, based on clinical trials showing their effectiveness.

“To me, that data still reigns supreme,” said Choudhry, who wrote an editorial published with the study. “These findings don’t support abandoning what we’re doing now,” he added.

Kronish and his colleagues combined the results of 15 studies looking at people’s adherence to their blood pressure prescriptions. Most of those studies defined “adherence” according to whether people persistently filled their prescriptions over the course of the study, which was a year in most cases.

On average, 65 percent of ARB users adhered to their medication, versus 58 percent of ACE inhibitor users and 51 percent of diuretic users. Beta-blockers had the lowest adherence : 28 percent.

When other factors were weighed in — including patients’ age, race and income — both diuretic and beta-blocker users were nearly twice as likely to stop taking their medications as ARB users were.

Choudhry said it is reasonable to believe that diuretic users could be more likely to quit because of the medications themselves.

It is likely that some people are bothered by the fact that diuretics cause frequent bathroom trips, as it helps to rid the body of water and salt.

Also, Choudhry said diuretics are older blood pressure drugs, and some patients perceive them as “not as good” as newer ARBs and ACE inhibitors.

“But we know from large-scale studies that people do just as well on diuretics as they do on other drugs,” Choudhry said.

A decade-old clinical trial, known as ALLHAT, found then that diuretics were more effective than other blood pressure medications at preventing heart failure, which was the key in making the most popular choice in the first place.

A range of factors, from price to potential side effects, can affect a person’s decision to adhere to any one type of blood pressure medication, said Choudhry. ARBs are more expensive than other drugs, while ACE inhibitors can cause a chronic cough.

But despite those factors, people should not stop taking medication on their own. “It’s very important to take the medication you are prescribed,” said Choudhry. “If you are having trouble, talk with your doctor.”

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