You might want to label the latest good news about high blood pressure (HBP) pills, ‘Hats Off to ALLHAT’.
You see, these days every study gets a fancy name with an acronym attached (CREST, MRFIT, and so on) in order to make the results of the study more memorable for everyone (hey, doctors are no different than you are: we also forget lots of stuff unless we have mnemonic devices to help us), and of the thousands of HBP studies that have been done, the most famous one without doubt is ALLHAT because if your doctor is in the least bit interested in blood pressure, there’s a very good chance he or she will know what the ALLHAT study concluded, and all the controversy that conclusion came to.
Thus, when the first ALLHAT results were announced, the conclusion was pretty simple: in a 3-way race of HBP pills that compared an old, pretty cheap but tried-and-true generic diuretic (the kind of blood pressure pill that doctors have been using for decades) to two new HBP drugs, a calcium channel blocker and an ACE inhibitor, the researchers concluded that the diuretic was the best drug. Period.
Many experts, however, refused to accept those ALLHAT conclusions, arguing that if the study had just gone on a few years more, it’s likely that the newer (and much more expensive drugs) would edge out the diuretic at lowering the rate of complications (strokes, kidney damage, heart attacks, etc.) from high blood pressure.
So guess what?
An update on ALLHAT has just been released at a major conference in China, and while the edge for the diuretic has narrowed somewhat, after 8-13 years, the best you can say about the other drugs is that they are no better than the diuretic at lowering complications from HBP (in fact, there is some room to argue that the new drugs are somewhat worse since one of them led to a higher risk of strokes in this study, while the other produced a higher risk of heart failure).
Now, this doesn’t mean that a person taking an ACE inhibitor or a calcium channel blocker should instantly stop their drug and start on a diuretic but it certainly implies that anyone on one of these pills might want to at least talk to their doctor about whether they should continue with those meds.
Interesting. My doctor had me try a diuretic alone first for a few weeks, it only helped a little, then he added the ACE inhibitor Ramipril and it worked much better.
The combo works well, but periodically I stop taking both to see what happens and my BP rises back up.
Would be good if I could just use the diuretic as it is inexpensive and the Ramipril side effects (dry cough) are eliminated.