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Doctors have an array of modern drugs available for fighting hypertension, but a study suggests that two old stand-bys, less expensive than the others, may do the best job of lowering blood pressure.Two classes of drugs -- diuretics and beta-blockers -- most effectively lowered blood pressure with the fewest adverse side effects in the study published in the March issue of the journal Hypertension.
Dr. H. Mitchell Perry, Jr., a hypertension specialist at Washington University School of Medicine, St. Louis, Missouri, led the team of researchers that analyzed data on 6,100 veterans treated at six outpatient screening and treatment clinics conducted by the US Department of Veterans Affairs.
Physician assistants and nurses, all with advanced training in treatment of hypertension, staffed the clinics under physician supervision. Instead of following a traditional research protocol, in which patients are randomly assigned to certain treatments, the staff decided which drugs to prescribe in each case.
"Unlike the more rigid, double-blind, placebo-controlled studies, this one simply says that we have a group of hypertensive patients and we're going to let the individuals who provide the care decide which drug to use and how enthusiastically to push it," Perry explained in a press release.
In this "real-world" setting, over 46 months, treatment with diuretics alone or in combination with a beta-blocker resulted in the greatest reduction in blood pressure.
All of the medications used in the study, including calcium channel blockers and ACE inhibitors, brought blood pressures down to the goals set by the researchers. But an overall pattern appeared: lower blood pressures with the older drugs and higher blood pressures with the newer agents.
In a second part of the study, researchers will examine the data for information on side effects and patient mortality.
Doctors also await the results of a much larger study, scheduled for completion in 2001, which will compare three of the newer antihypertension drugs to diuretics.
This research trial, funded by the Department of Veterans Affairs and the National Heart, Lung, and Blood Institute, "should answer the bottom-line question: Are any of the currently used antihypertensive agents more effective than others in preventing death or heart attacks or strokes?" Perry said.
Thursday March 26, 98
SOURCE: Hypertension
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