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Diuretics Cut Blood Pressure as Well as Newer Drugs
Posted by Shirley S. Wang
An assortment of blood pressure medicines don’t prevent heart attacks and death any better than an old-fashioned diuretic in patients suffering from metabolic syndrome, according to a study published in the Archives of Internal Medicine.
It’s a symbolic blow to brand-name blood pressure drugs, including calcium-channel blockers and ACE inhibitors, that were mainstays of some of Big Pharma’s heavyweights. Pfizer’s Norvasc, part of the test, went generic in the U.S. last year.
“Because of differing effects on blood sugar and cholesterol, it was postulated, and for that matter assumed, that these drugs would have a more favorable effect on heart attack, strokes, kidney disease and heart failure” than diuretics, lead author Jackson Wright, a professor of medicine at the University Hospitals Case Medical Center, told the Health Blog.
The original results from Allhat, short for the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, showed that wasn’t the case. Thiazide-type diuretics, or water pills in one of medicine’s quainter euphemisms, fared just as well as the other medications in preventing cardiac events and death. Diuretics lower blood pressure by ridding the body of excess fluid and salt in the urine.
Still, some in the field wondered whether diuretics were truly equivalent in patients at highest risk for cardiac events, such as those with metabolic syndrome. ACE inhibitors and alpha blockers are known to lower cholesterol and glucose while diuretics increase them, according to Wright.
So the researchers examined in this latest analysis those participants in the 42,418-patient trial, funded by the government and Pfizer, who had high blood pressure and at least two other symptoms of metabolic syndrome — being obese (BMI over 30), having diabetes or pre-diabetes, high triglycerides or low levels of “good”, HDL cholesterol — which was about half the sample.
The results showed that even within this high-risk sample, the three types of hypertension medications with better metabolic profiles — alpha-blockers, ACE inhibitors, or calcium channel blockers (which include Pfizer’s Norvasc and Cardura, Merck’s Prinivil and AstraZeneca’s Zestril) — were no better than diuretics in preventing cardiac events, end-stage renal disease and ultimately death.
And for black patients, those taking ACE inhibitors faired significantly worse that those who took diuretics.
“As with all the other Allhat publications, in no case were in fact the newer agents more beneficial in any of the outcomes,” says Wright. “Importantly, in black patients, the differences were exaggerated in patients receiving ACE inhibitors.” 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-03-28 05:14
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