Hypertension therapies, ACE inhibitors and calcium channel blockers are more expensive and may be no better than using a generic diuretic for preventing cardiovascular disease, according to the results of a substudy of the ALLHAT trial presented Aug. 13 at the China Heart Congress and International Heart Forum in Beijing.
ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack), a randomized, double-blind trial, enrolled 42,418 high blood pressure patients and compared chlorthalidone (a diuretic) to the calcium channel blocker amlodipine besylate, the alpha-blocker doxazosin mesylate and the ACE inhibitor lisinopril.
Paul Whelton, MD, of the Loyola University Health System, and colleagues followed up almost 33,000 patients for an additional four to five years, extending the follow-up period of the ALLHAT trial to eight to 13 years.
Whelton et al found that the differences between the three drugs—chlorthalidone, amlodipine and lisinopril—narrowed, and were in a “statistical dead heat.”
However, the results did show that the diuretic chlorthalidone performed better than the ACE inhibitor and the calcium channel blocker. Patients administered lisinopril had a 20 percent higher rate of death from stroke compared to those on diuretics. Additionally, patients administered amlodipine had a 12 percent higher incidence rate of hospitalization and death from heart failure.
While the National Heart, Lung and Blood Institute (NHLBI) recommends that patients first attempt to lower blood pressure by lifestyle changes such as weight loss, exercise and decreased salt, diuretics are considered first-line therapy.
However, only 30 percent of the drugs prescribed for hypertension are diuretics, which cost an estimated $25 to $40 per year. In comparison, brand-name drugs indicated to treat hypertension cost between an estimated $300 and $600 per year.
ALLHAT was sponsored by the NHLBI.