Managed Care

Strengthening diuretics’ role in hypertension

Back in 2002, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) examined the comparative value of different blood pressure-lowering medications. More than 33,000 patients 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). They followed these patients for four to eight years.

Researchers continued to follow these patients for an additional four to five years and the differences between the medications narrowed, but the diuretic was still superior in two measures: Patients taking the ACE inhibitor 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 caused by heart failure.

“Diuretics are a sensible starting point and an important component of any combination of drugs to help control hypertension,” says Paul Whelton, MD, president and CEO of Loyola University Health System and chairman of the ALLHAT study. “Concurrently, they are also very inexpensive.”

In the graph, chlorthalidone is the diuretic, amlodipine is the calcium channel blocker, and lisinopril is the ACE inhibitor.

Confidence intervals are used to indicate the reliability of an estimate, instead of using a single value.

CVD and all-cause mortality outcomes (95% CI)

Source: ALLHAT Collaborative Research Group. JAMA 2002;288:2981–97

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