Diuretics: Wrong Meds for BP?

 

If you're a postmenopausal woman with high blood pressure and you're taking diuretics to treat your condition, you're far from alone. However, a new study shows that if you are at a healthy weight, diuretics may not be the best choice for protecting you against heart disease. In fact even if you are overweight but not clinically obese, diuretics are probably the wrong meds for you. Michael Weber, MD and colleagues of SUNY Downstate Medical Center in Brooklyn, N.Y. reported these findings at a meeting of the American Society of Hypertension.

 

The news is surprising in light of the fact that for years, diuretics have been the drugs most likely to be prescribed for hypertension. A report on WebMD dated December 17th 2002 said: "When it comes to medications to treat high blood pressure, newer isn't necessarily better. In fact, researchers say that in light of new findings from a landmark study, diuretics should be the top choice for combating high blood pressure." And the Mayo Clinic site still has this to say about treating high blood pressure: "Your doctor may first suggest diuretics — also called water pills . . . Thiazide diuretics typically have fewer side effects than do other types of diuretics. They also offer strong protection against conditions that high blood pressure can cause, such as stroke and heart failure."

However, thiazide diuretics were precisely the ones implicated as being risky in Weber's analysis of the "Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial, which was conducted at 548 centers in the U.S., Sweden, Norway, Denmark, and Finland. According to MedPage Today, Weber said that in non-obese patients "thiazides may stimulate certain adverse mechanisms -- including increased activity in the sympathetic and renin angiotensin systems -- that result in poorer cardiovascular outcomes compared with those seen in obese patients." The medication cocktail that turned out to work best for non-obese patients in Weber's study was a combination of the ACE inhibitor benazepril (brand name Lotensin) and the calcium channel blocker amlodipine (brand name Norvasc.) Although Weber's research should be considered preliminary until published in a peer-reviewed journal, you might do well to ask your doctor about changing your medication regimen if you are currently on diuretics.   
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