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Cheapest drug called best for hypertension

Compiled from Times wires
© St. Petersburg Times
published December 18, 2002

Inexpensive diuretics are more effective than newer, more expensive hypertension drugs in preventing deaths from heart disease, and using the old-fashioned "water pills" more widely could save 60,000 lives and hundreds of millions of dollars per year, according to the first head-to-head comparison of the drugs.

Diuretics, which ease the load on the heart by forcing the body to excrete excess water and sodium, should be the first choice of drugs for physicians treating the estimated 50-million Americans with hypertension, researchers said, and patients already receiving other drugs should have diuretics added to their regimens.

The other hypertension drugs, which include calcium channel blockers like amlodipine (sold under the brand name Norvasc) and ACE inhibitors like lisinopril (Zestril and Prinivil), had previously been shown to be more effective than placebos, but they had never been tested against diuretics.

"Yet these more costly medications were often promoted as having advantages over older drugs," said Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute, which sponsored the study.

"The take-home message is that doctors should begin drug treatment for high blood pressure with a diuretic," said Dr. Paul Whelton, senior vice president for health sciences at Tulane University and a coordinator of the study. The findings "also indicate that most patients will need more than one drug to adequately control their blood pressure, and one of those drugs used should be a diuretic."

Dr. Jackson T. Wright Jr. of Case Western Reserve University, who was vice chairman of the study's steering committee, said, "The hope is that we make it easier for both providers and patients to achieve blood pressure control using the most effective, as well as least costly, medication."

The study, published today in the Journal of the American Medical Association, did not look at some even newer drugs, however, and did not consider the effects of combinations of drugs.

The eight-year study involved 33,357 patients age 55 and older from 623 sites in the United States, Canada, Puerto Rico and the U.S. Virgin Islands. It compared the generic diuretic chlorthalidone with the ACE inhibitor lisinopril and the calcium channel blocker amlodipine.

A third blood pressure drug, the alpha blocker doxazosin, was dropped from the study more than two years ago because it proved significantly less effective than diuretic treatment.

The findings show a slightly greater percentage of patients got their blood pressure below 140/90, the threshold for high blood pressure, when they used the diuretic compared to the two newer medicines.

Researchers also found the diuretic was better than the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure and chest pains.

Diuretics were the main course of treatment for hypertension until other drugs were developed. As recently as 1982, they were prescribed to 56 percent of patients receiving treatment for high blood pressure. But only a decade later, that proportion had fallen to 27 percent. Fully two-thirds of the $15-billion spent each year on blood-pressure drugs now goes to calcium channel blockers and ACE inhibitors, experts said.

Norvasc, produced by Pfizer Inc., is the bestselling brand-name hypertension drug in the world, with sales of more than $3.5-billion each year. It costs patients between $1.40 and $1.60 per day. The most widely used diuretics, in contrast, cost about 6 to 10 cents per day. Had patients stuck with diuretics between 1982 and 1992, Lenfant said, they and their insurers would have saved $3.1-billion.

Experts cautioned that patients now taking other drugs should continue taking them and consult with their physicians about the possibility of switching to diuretics or adding them to their regimens. Many patients will require the use of more than one drug to keep their blood pressure under control, said Dr. L. Julian Haywood of University of Southern California, and some patients are not good candidates for diuretics, such as those with kidney problems and electrolyte or fluid imbalances.

-- Information from the Los Angeles Times, Associated Press and Scripps Howard News Service was used in this report.

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