Pricey drugs to reduce blood pressure appear no better at preventing heart disease than cheap, generic diuretics, which have been around for decades.
This is the result of a 13-year study of roughly 33,000 Americans who use anti-hypertensive drugs. The hypertension patients were randomly assigned in the 1990s to receive either a diuretic (a water pill, controlling sodium levels and blood pressure by making you urinate), a calcium channel blocker, or an ACE inhibitor. The patients then took those drugs through the years that followed. More than a decade later, it would seem that there is basically no difference at all between the treatments in preventing stroke, heart failure, or heart disease in general. But diuretics cost just 5%-10% what the fancier drugs can cost. A typical prescription is less than $50 per year.
The finding was presented Friday at a heart conference in Beijing by the chairman of the study: ALLHAT, or the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. The new results have not yet been published in a peer-reviewed journal. But earlier results from the same trial were published in the Journal of the American Medical Association in 2002, and showed that, after just four to eight years of follow-up, the cheaper drugs in fact performed better than calcium channel blockers or ACE inhibitors at preventing major heart disease. The difference between the treatment groups has now narrowed somewhat with the extra years, so that after eight to 13 years of follow-up, all three treatments appear to perform about the same on most major indicators. The diuretics still beat out the bigger-name drugs on two measures, however, according to a statement from Loyola University. Compared to the water pill, the ACE inhibitor group had a 20% higher death rate from stroke, and the calcium channel blocker group had a 12% higher death rate from heart failure.