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Diuretics show some advantages in treating high blood pressure You take prescription pills at $1 or more a day to control your high blood pressure. Now a major study concludes that less expensive diuretics the same ones your mom used to take are just as good as, and in some cases better than, newer, costlier medications in treating high blood pressure and preventing life-threatening complications for many people. What should you do? Talk to your doctor about taking diuretics as your first choice if you need to take medications to treat high blood pressure Diuretics aren't an option for everyone. But the study concludes that for many people, a type of diuretic known as thiazides is superior to angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists (calcium channel blockers) in preventing one or more major types of cardiovascular disease. The diuretics also tend to have fewer and less severe side effects, making it easier to stay on your medication. In addition, the diuretics cost less. Reducing your risksThe goal of any treatment is to both lower your blood pressure and prevent complications. High blood pressure can cause life-threatening cardiovascular problems, including stroke, heart attack, heart failure, kidney failure and dementia. Simply making lifestyle changes such as increasing activity, maintaining a healthy weight, limiting alcohol consumption, eating a healthy diet while decreasing sodium intake, and stopping tobacco use is often enough to control your blood pressure and reduce your risk of complications. In fact, lifestyle changes are the best and safest way to control your blood pressure. But if you've made the necessary lifestyle changes and your blood pressure still isn't sufficiently under control, high blood pressure medications (antihypertensives) can help. However, just because antihypertensives can reduce your blood pressure doesn't mean the different kinds are necessarily equally good at reducing your risk of developing certain complications or dying. Although doctors have long known the benefits of taking antihypertensives, it hasn't been clear which medication regimen was best at doing both controlling your blood pressure and preventing complications. Diuretics sometimes called water pills were introduced in the 1950s and are still commonly used for high blood pressure. Meanwhile, newer classes of drugs have become available, such as ACE inhibitors, calcium channel blockers, alpha-adrenergic blockers and angiotensin receptor blockers. These newcomers began crowding out the older diuretics, even though they cost more and lacked convincing evidence that they were more effective. Today, eight classes of medications with many types in each class are on the market, and more are in development. Sometimes people think that newer is better or that more expensive is better. But the ALLHAT (antihypertensive and lipid lowering to prevent heart attack trial) study shows that's not necessarily true. A look at the studyThe study, which began in 1994 with 42,000 adults, pitted a type of diuretic against three of those newer classes of antihypertensives. The intent was to see which, if any, was better at reducing the incidence of fatal coronary heart disease, heart attacks, overall deaths and other problems for people at high risk of developing complications from high blood pressure. One part of the study was stopped several years ago when results showed that participants taking an alpha blocker (doxazosin) had higher rates of heart failure than people taking a diuretic did. The remaining section of the study enrolled more than 33,000 adults age 55 and older with high blood pressure and at least one other condition that can cause coronary heart disease, making it one of the largest studies of its kind. It included men and women, minorities, people with high-risk habits, such as smoking, and others with high-risk medical conditions, including high cholesterol, diabetes, or a previous stroke or heart attack. Those participants were randomly chosen by a computer to take one of three medications:
Researchers monitored progress of the participants during 8 years to see which medication was most effective, looking at how well blood pressure was controlled, what complications occurred and causes of death for those who died while in the study. Among the study's results, reported in the Journal of the American Medical Association in December 2002:
That's not to say the two newer drugs are ineffective. To the contrary, each is effective in controlling blood pressure and reducing complications. But some antihypertensives are better at it than others or do it equally well at a lower cost. The study confirms the long-established value of diuretics. Using common, everyday drugs, most people can achieve blood pressure control. Although the ALLHAT study didn't include hypertension medications that came on the market after it began, that doesn't detract from the findings, because the studied medications are still commonly used.
The bottom line: Less costDiuretics have an added benefit: They're cheaper than other antihypertensives. That adds up to savings for both individuals and society. Although prices can vary by location, chlorthalidone is available as a generic prescription starting around 5 cents a pill, depending on dosage. Lisinopril, which is also available as a generic, is available starting around 30 cents a pill. Amlodipine, which is not available as a generic, starts around $1.20 a pill and can go up to more than $2 a pill, depending on dosage. You might have to take some of these medications more than once a day, and you'll likely have to take them the rest of your life. Small differences in price can have a big impact, especially when you consider you could be taking these medications for 30 years or more.
What should you do?The results of this one study don't necessarily mean that you should or can switch to a diuretic. Diuretics aren't effective for everyone, and some people can't take them because of medical issues, such as allergies or intolerable side effects. And certainly, don't stop taking your current medications or change the dose without consulting your doctor. In addition, some drugs are effective for other medical conditions you might have along with hypertension. ACE inhibitors, for example, are important in the treatment of congestive heart failure and some types of kidney disease. Your doctor may be using a specific drug for several different reasons. What, then, should you do if you have high blood pressure? If your blood pressure is well controlled, talk to your doctor about your situation. Discuss your risk factors for developing cardiovascular disease to see if you should change the type of medication you take or add medications to your regimen. If your blood pressure isn't well controlled and you're not at your goal, talk to your doctor about adding a diuretic to your medication regimen or substituting a diuretic for your current medication. Most people diagnosed with high blood pressure who must take medications can start with a diuretic, regardless of their sex or age. If the diuretic isn't sufficient, your next step is to consult with your doctor about adding an ACE inhibitor, calcium channel blocker, beta blocker or an angiotensin receptor blocker. If that's still not enough to control your blood pressure, you might need to take an alpha blocker or central acting agent. Persistence pays off. At the start of the ALLHAT study, only one in four participants had their blood pressure under control with medications. By the end of the study, two-thirds had it controlled, with a blood pressure of less than 140/90 mm Hg, and about half of them were taking just one of the study drugs. Don't be satisfied until you meet your blood pressure goal.
Dry Skin (xerosis)
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The diuretic chlorthalidone (Hygroton, Thalitone) 