ACE inhibitors are better first choice than diuretics for elderly patients, study says

Some doctors are criticising a recent government sponsored clinical trial that found diuretics to be the best first option for treating high blood pressure in elderly people.

Critics say the results from the 10 year study, known as ALLHAT (the antihypertensive and lipid lowering to prevent heart attack trial) and published in December to wide publicity (JAMA 2002;288:2981-97), overstated the case for diuretics and contradicted clinical experience.

These critics are getting some backing from a new study published this week in the New England Journal of Medicine (2003;348:583-92), which suggests that angiotensin converting enzyme (ACE) inhibitors are a better first choice for older patients, leading to fewer deaths, heart attacks, strokes, and other cardiovascular problems.

In the trial 6083 people …