Diuretics, Stress Training Ease Hypertension

Diuretic drugs and stress counseling were found to be at least as effective as other remedies in helping patients stave off the fatal consequences of high blood pressure, two studies said on Tuesday.

One in four U.S. adults has high blood pressure and its prevalence increases with age, putting patients at risk of suffering a heart attack or stroke, the reports published in this week’s Journal of the American Medical Association said.Heart disease is the leading cause of death in the developed world.A 33,000-patient study comparing a relatively inexpensive diuretic drug with more costly ACE inhibitors and calcium channel blockers found the diuretic — sometimes called a water pill because it eliminates salt and water from the kidneys — was as effective or more effective than the others when judged by how well they staved off serious heart ailments.The study’s initial conclusions focused on the benefits to blacks initially diagnosed with high blood pressure, but the latest findings extended the finding to all races. Blacks have among the highest incidence of hypertension.”While some other recent studies have evaluated newer therapies (including drug combinations), the weight of evidence, particularly in this multiracial study, supports the diuretic recommendation,” said study co-author Jeffrey Cutler of the National Heart, Lung, and Blood Institute.Not only was the thiazide class of diuretic better tolerated by patients, but it was more effective in preventing the major complications of high blood pressure such as heart failure, the report said.”It is now time to move beyond comparisons of diuretics with other classes of (blood pressure)-lowering drugs — that issue has been settled,” wrote James Neaton of the University of Minnesota and Lewis Kuller of the University of Pittsburgh in an accompanying editorial.In a second study of 134 patients already suffering from heart disease, those who participated in a four-month stress management course reduced their risk of developing more heart problems.In some cases, stress management was more effective than a three-times-weekly aerobic exercise program, the report said.Learning to handle stress — and the accompanying surges in blood pressure, a major heart risk factor — improved the health of their blood vessels by 25 percent, said study author James Blumenthal of Duke University in Durham, North Carolina.(Source: Journal of the American Medical Association: Reuters Health: April 2005.)