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ACE inhibitors work less well in black patients with high blood pressure

Diuretics work better than newer therapies in treating high blood pressure and reducing risk of heart disease in both black and non-black patients, according to a long-term, multicenter trial of antihypertensive therapies funded by the National Heart, Lung, and Blood Institute ( NHLBI ) of the National Institutes of Health ( NIH ).

This analysis by race confirms earlier findings on the effectiveness of diuretics and emphasizes that diuretics should be preferred as a first therapy for most patients with high blood pressure.

ALLHAT is the first large scale trial — with 33,357 participants — to compare diuretics, calcium channel blockers, and ACE inhibitors as initial therapies in a population with a substantial number of black participants.

The study concludes that diuretics are either similar or superior to newer drugs in lowering blood pressure, in tolerability, and in preventing the major complications from high blood pressure.

Across both racial subgroups, there was substantially higher risk of heart failure — 37 percent — among participants taking calcium channel blockers compared with those on diuretics.

When compared with ACE inhibitors, diuretics were more effective in preventing cardiovascular disease, especially heart failure, for all participants and significantly more effective in reducing high blood pressure and preventing stroke in blacks.

Based on this study finding, the authors conclude that as the initial drug for treating high blood pressure, ACE inhibitors work less well than alternatives in black patients.

“ This analysis confirms and extends to all races ALLHAT’s original conclusion that diuretics are the right first-line therapy for high blood pressure. While some other recent studies have evaluated newer therapies ( including drug combinations ), the weight of evidence, particularly in this multi-racial study, supports the diuretic recommendation,” said Dr. Jeffrey Cutler, NHLBI Senior Analyst and study co-author.

The study has been published in JAMA.

High blood pressure affects about 65 million Americans, or one in four adults, and its prevalence increases with age — more than half of those over age 60 have hypertension.
High blood pressure is a risk factor for heart disease and the chief risk factor for heart failure and stroke.

Source: NIH, 2005