Diuretics are as effective as ACE inhibitors and channel blockers

Thiazide-type diuretics reduce cardiovascular events as much as angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers in patients with hypertension. This is the finding of the first major study, published just before Christmas, to directly compare different classes of antihypertensives. The “antihypertensive and lipid lowering to prevent heart attack trial” (ALLHAT), which studied 33357 people aged 55 years and older with hypertension and at least one other risk factor for coronary heart disease, has been described as one of the most important trials of antihypertensive treatment. The trial was conducted by the ALLHAT Collaborative Research Group in 623 North American centres, and the findings were published in JAMA (2002;288:2981-97). It randomised the study participants to one of three antihypertensive regimens: the thiazide diuretic chlortalidone (12.5-25 mg a day; n=15255); the ACE inhibitor lisinopril (10-40 mg a day; n=9054), and the calcium channel blocker amlodipine (2.5-10 mg a day; n=9048). …