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In the ALLHAT double-blind randomized trial from a year ago, U.S. researchers found that a thiazide diuretic (chlorthalidone) was the most effective of several first-line therapies for hypertension, including the ACE inhibitor lisinopril (Journal Watch Cardiology Jan 31 2003). A few months later, Australian researchers published results of an open-label randomized trial of hydrochlorothiazide (3039 subjects) versus enalapril (3044 subjects) in hypertensive patients (age range, 65-84; 95% white; mean BP, 168/91 mm Hg) recruited from family-practice settings. Among the exclusion criteria were any recent adverse cardiovascular events and serum creatinine level >2.5 mg/dL. The study was partly supported by a manufacturer of enalapril.
The random…