Diuretics best BP therapy for blacks

New data fail to support the idea that newer drugs have advantages over diuretic “water pills” for people with high blood pressure (BP), whether or not they have the “metabolic syndrome” - a cluster of conditions that include obesity, high triglycerides, and insulin resistance as well as hypertension.

The findings come from a large trial called ALLHAT, which compared different types of blood pressure treatments.

“The findings are especially true in African-American hypertensives,” said ALLHAT researcher Dr. Jackson T. Wright, from Case Western Reserve University School of Medicine in Cleveland. He presented the data this past weekend at the International Society on Hypertension in Blacks in San Juan, Puerto Rico.

The ALLHAT group analyzed rates of cardiovascular and kidney complications among more than 18,100 hypertensive patients with the metabolic syndrome, of whom 5,763 were African American, and 11,180 without the metabolic syndrome, of whom 4,277 were African American.

Metabolic syndrome Overview

Sometimes, the whole really is greater than the sum of its parts. Such is the case with metabolic syndrome.

Metabolic syndrome isn’t a disease, but is a cluster of disorders of your body’s metabolism - including high blood pressure, high insulin levels, excess body weight and abnormal cholesterol levels - that make you more likely to develop Diabetes, Heart disease or Stroke. Each of these disorders is by itself a risk factor for other diseases. In combination, though, these disorders dramatically boost your chances of developing potentially life-threatening illnesses.

Doctors have talked about this constellation of risk factors for years, and have called it many names, including syndrome X, the deadly quartet and insulin resistance syndrome. But several studies support what doctors have suspected all along - this syndrome is common and it’s becoming more prevalent. As many as one in four American adults and 40 percent of adults age 40 or older have metabolic syndrome, an increase of 61 percent over the last decade.

Partly because of these increasing numbers, doctors have defined the syndrome more clearly and developed guidelines for diagnosing it. Now, this powerful predictor of disease is a valuable preventive tool. If you have metabolic syndrome, you have the opportunity to make aggressive lifestyle changes today that can delay or derail the development of serious diseases.

As part of ALLHAT, these individuals were randomly assigned to a diuretic (chlorthalidone), a calcium channel blocker (amlodipine) or an ACE inhibitor (lisinopril).

After nearly 5 years of treatment, “neither the calcium channel blocker nor the ACE inhibitor was superior to the diuretic in preventing any cardiovascular outcome in patients with and without the metabolic syndrome,” Wright said.

“In fact, the diuretic was more effective than the ACE inhibitor and the calcium blocker in preventing heart failure and also more effective than the ACE inhibitor in preventing Stroke in African Americans with the metabolic syndrome,” he said.

Metabolic syndrome creates a real risk of developing diabetes, stroke or heart disease. The good news is that you’ve been given advance notice, so you can do something about it. You can curb your insulin resistance by making these lifestyle changes:

  • Lose weight. Losing as little as 5 percent to 10 percent of your body weight can reduce insulin levels and high blood pressure, and decrease your risk of diabetes.  
  • Exercise. Walking just 30 minutes each day or engaging in other aerobic activities can help prevent the serious diseases associated with metabolic syndrome.  
  • Stop Smoking. Smoking cigarettes increases insulin resistance and worsens the health consequences of metabolic syndrome. Talk to your doctor if you need help kicking the cigarette habit.  
  • Eat fiber-rich foods. Make sure your grocery cart includes whole grains, beans, fruits and vegetables. These items are packed with dietary fiber, which can lower your insulin levels.

“Diuretic therapy remains preferred over ACE inhibitors or calcium channel blockers, as the initial antihypertensive medication, even in the presence of metabolic syndrome in African-American hypertensives,” Wright said in a statement.

Provided by ArmMed Media
Revision date: July 9, 2011
Last revised: by Dave R. Roger, M.D.