Researchers stand by diuretics as first line treatment for hypertension

BMJ 2009; 339 doi: (Published 30 November 2009) Cite this as: BMJ 2009;339:b5119
  1. Jacqui Wise
  1. 1London

    Researchers who have completed a 10 year follow up of the ALLHAT study say that they stand by their original conclusion that diuretics are as effective as other, more expensive options for treating hypertension and should be used as the first line treatment.

    The original ALLHAT (antihypertensive and lipid lowering treatment to prevent heart attack trial) study caused some controversy when it concluded that an older cheap drug might do as well as, and may actually be better than, newer and more expensive antihypertensive drugs (JAMA 2002;288:2981-97, doi:10.1001/jama.288.23.2981).

    In the original double blind trial 42 000 participants were randomised to initial treatment with one of four classes of drug then in use: the α adrenoceptor blocker doxazosin, the angiotensin converting enzyme (ACE) inhibitor lisinopril, the calcium channel blocker amlodipine, and the thiazide diuretic chlortalidone.

    The doxazosin arm was stopped after three …

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