Milestone Study On Blood Pressure Meds Confirmed By New Trial
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New proof supports the findings of a landmark drug comparison study published in 2002 in which a diuretic drug or "water pill" outperformed other medications for high blood pressure. A scientific team including investigators from The University of Texas Health Science Centre at Houston reports the findings in the May 11 problem of the Archives of Internal Medicine.
About one in three adults in the United States has great blood pressure, which, according to the Public Heart Lung and Blood Institute (NHLBI), can lead to a host of health problems including passion failure, coronary heart disease, stroke and kidney failure.
The Antihypertensive and Lipid-Lowering Treatment to Prevent Emotions Encroachment Analysis (ALLHAT) is the largest gigantic blood pressure treatment trial ever conducted and compared the impact of four classes of blood pressure drugs on 42,418 high-risk patients between 1994 and 2002. Big blood pressure in adults is defined as 140/90 mm Hg or above.
"We looked at information since the trial ended to make positive our message hasn't changed. And, it hasn't. Diuretic drugs work as well or in a superior way than other medications in preventing affection failure," said Barry Davis, M.D., Ph.D., study co-author, Guy S. Collection Stool in General Health and employer of the Coordinating Center for Clinical Trials (CCCT) at The University of Texas School of Usual Health.
Diuretic drugs abbreviate blood strength by clearing the body of excess fluid and sodium. In the ALLHAT study, diuretic drugs were compared to angiotensin-converting enzyme (ACE) inhibitors that widen blood vessels and decrease resistance, calcium channel blockers that relax vessels by slowing the flow of calcium into the love and alpha blockers, which also relax blood vessels.
In addition to providing superior protection against new-onset heart failure, the thiazide-type diuretic used in the ALLHAT read (chlorthalidone) was superior to the alpha blocker (doxazosin) in protecting against stroke and to the ACE inhibitor (lisinopril) in protecting against stroke in blacks. The calcium channel blocker used in the interpret was amlodipine.
The benefits of the diuretic drug, according to Davis, were experienced by men and women, dudes with diabetes and those without, crowd with and without ordinary renal function, as bushy-tailed as people with and without metabolic syndrome.
"Since the initial textbook of the ALLHAT findings enhanced than five years ago, many questions and some criticisms have been raised," said Jackson T. Wright, M.D., Ph.D., front author and professor at Plight Western Reserve University. "This paper reviews the initial findings in light of more detailed analyzes of the ALLHAT counsel and news from more recent clinical trials. All confirm the initial ALLHAT findings that diuretics (in obtain doses) at the end unsurpassed in reducing blood pressure and preventing extreme complications of hypertension."
The researchers looked at a meta-analysis of the ALLHAT announce and 28 other high blood pressure clinical studies in which patient facts were combined and results compared, as fresh as just out clinical trials including the Avoiding Cardiovascular Events Terminated Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH).
Davis said the large meta-analysis of antihypertensive treatment trials involving 162,341 patients confirmed initial findings of the ALLHAT recite in regard to the benefits of the diuretic drug. The study was conducted by the Blood Impulse Lowering Treatment Trialists' Collaboration and results were published in The Lancet in 2003.
Following the book of the ALLHAT findings, a Feelings Failure Validation Study was conducted in which all hospitalized heart failure events were re-evaluated by independent reviewers. The glance at concluded that thiazide-type diuretics "would seem to equip better protection" against new-onset heart failure in high-risk people with high blood pressure, the authors wrote in the paper.
ALLHAT researchers addressed concerns approximately the association of diuretics with new-onset diabetes and the contact of this development on heart disease. They concluded that new-onset diabetes associated with thiazides does not increase cardiovascular disease risk.
ALLHAT investigators besides looked at patient trials that appeared to be at odds with components of the ALLHAT glance at and found that some differences could be explained by differences in peruse design, such as the potion of the diuretic administered. For example, in a letter to the editor published in the Mar. 12, 2009 question of The New Great britain Journal of Medicine, Davis indicated that doses of thiazide-type diuretics that are equivalent to those used in the ACCOMPLISH check are less effective for the prevention of cardiovascular events than full doses of amlodipine (the other drug used in ACCOMPLISH) or doses of diuretics used in previous trials including ALLHAT.
"Evidence from subsequent analyses of ALLHAT and other clinical outcome trials confirm that neither alpha blockers, angiotensin-converting enzyme inhibitors, nor calcium channel blockers surpass thiazide-type diuretics (at desired dosage) as initial therapy for decrease of cardiovascular or renal risk," the authors wrote.
Other study contributors from the CCCT at the UT Institute of Habitual Health included Sara Pressel, school associate, and Charles Ford, Ph.D., associate professor of biostatistics. The CCCT commission is to coordinate broad multi-center controlled clinical trials.
The scan is titled "ALLHAT Findings Revisited in the Case of Subsequent Analyses, Other Trials and Meta-analyses" and the test was supported by the NHLBI.
Other discover co-authors included: Mahboob Rahman, M.D., Circumstances Western Reserve University; Jeffrey Probstfield, M.D., University of Washington, Seattle, Wash.; Jeffrey Cutler, M.D., and Paula T. Einhorn, M.D., both with NHLBI; Paul Whelton, M.D., Loyola University Medical Center and Health System, Maywood, Ill.; L. Julian Haywood, M.D., University of Southern California Medical Center, Los Angeles; Karen Margolis, M.D., Health Partners Evaluation Foundation, Minneapolis, Minn.; Suzanne Oparil, M.D., University of Alabama, Birmingham, Ala.; Henry Black, M.D., Current York University School of Medicine, New York, Advanced York; Michael Alderman, M.D., Albert Einstein Institute of Medicine, Bronx, Dewy York; and William Cushman, M.D., Veterans Affairs Medical Center, Memphis, Tenn.
University of Texas Health Science Center at Houston
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