Use a Thiazide Diuretic First for Hypertension

The ALLHAT hypertensive-study results are in, and the practice implications are clear.

ACE inhibitors (ACEIs) and calcium-channel blockers (CCBs) are superior to placebo for preventing adverse cardiovascular events, but how effective are they relative to diuretics? In the ALLHAT randomized study, researchers compared 3 antihypertensive agents -- a CCB (amlodipine; 2.5-10 mg/day), an ACEI (lisinopril; 10-40 mg/day), and an alpha-blocker (doxazosin) -- with standard diuretic treatment (chlorthalidone; 12.5-25 mg/day) in hypertensive patients aged 55 and older. The doxazosin arm was halted early because of increased adverse events (Journal Watch Cardiology Jun 16 2000), leaving 33,357 subjects (47% female; 32% black) in the other 3 arms.

At a mean follow-up of 5 years, systolic blood pressure was significantly higher among amlodi…

Reviewing Author

JoAnne M. Foody, MD