The Medical Letter on Drugs and Therapeutics
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A Diuretic for Initial Treatment of Hypertension?

Effective treatment of hypertension can prevent organ damage and death. The choice of drugs for initial treatment continues to be controversial.1

ALLHAT — In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind, 4.9-year study in more than 30,000 older (≥55 years) high-risk hypertensive patients, therapy based on the thiazide-type diuretic chlorthalidone 12.5-25 mg/day (used as the initial drug, but one or 2 drugs could be added) was as effective as the ACE inhibitor lisinopril (Zestril, Prinivil, and others) or the dihydropyridine calciumchannel blocker amlodipine (Norvasc, and others) in preventing the primary endpoint of fatal coronary heart disease or nonfatal myocardial infarction.2

For the secondary endpoint of all-cause mortality, there was no difference between the 3 drugs. ... more      

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