May 2, 2006
Diuretics first line against heart failure: study
WASHINGTON (Reuters) - Cheap diuretics are the best first
step in treating high blood pressure to prevent heart failure,
U.S. researchers reported on Monday.
Their study, published in the American Heart Association
journal Circulation, supports a 2002 U.S. government report
recommending that patients with high blood pressure should
start taking a diuretic first, and only add drugs such as ACE
inhibitors or beta-blockers if their blood pressure needs to be
the body of excess water, often making patients urinate more
often. In 1982 they were prescribed in 56 percent of the cases
of high blood pressure treated by drugs, but by 1992 they were
prescribed in only 27 percent of the cases.
Use has been creeping back up since the 2002 report by the
U.S. National Heart, Lung and Blood Institute.
"This study provides evidence for the superiority of
diuretics over calcium channel blockers and ACE inhibitors as
the base of an anti-hypertensive regimen to prevent heart
failure," said Dr. Barry Davis of the University of Texas
School of Public Health in Houston, who led the study.
High blood pressure forces the heart to pump harder to keep
blood circulating. Over time, this added workload can cause
heart failure, in which the heart becomes bigger but flabbier
and blood backs up.
Heart failure patients become increasingly tired and short
of breath and lose kidney function. Half die within five years
"Over 90 percent of people who develop heart failure first
had high blood pressure," said Davis.
"Diuretics are better than calcium channel blockers at
preventing heart failure, and better, at least in the short
term, than ACE inhibitors," Davis said in a statement.
"One reason diuretics may have an advantage over other
drugs is that they are good at decreasing the volume that the
heart has to deal with, and the other drugs don't do that. ACE
inhibitors remodel the heart, which may have a more long-term
effect on preventing heart failure."
His team analyzed data from the giant Antihypertensive and
Lipid-Lowering Treatment to Prevent Heart Attack Trial, or
ALLHAT, in which several drug companies donated their
name-brand products for use.
The cheaper, generic, diuretics did the best job of
lowering cholesterol and preventing heart failure.
During the first year of the study, patients given a
calcium-channel blocker or ACE inhibitor were 40 percent more
likely to be hospitalized or die from heart failure as patients
taking a diuretic.