Washington, January 29 : Diuretics may be helpful in reducing the incidence of heart disease among patients with the metabolic syndrome and high blood pressure, according to the researchers from The University of Texas School of Public Health and Case Western Reserve University.
Their suggestion is based on the results of a drug comparison trial involving 23,077 people with both high blood pressure and the metabolic syndrome, a cluster of risk factors for heart disease.
The results showed that blacks, who had a high incidence of high blood pressure, were particularly likely to derive the cardiac benefits connected with diuretics.
"In hypertensive patients with metabolic syndrome, initial treatment for hypertension should include a diuretic," said senior author Dr. Barry Davis, professor of Biostatistics and the director of the Coordinating Center for Clinical Trials at the UT School of Public Health.
"Diuretics are preferred over other major classes of blood pressure medications to prevent one or more forms of cardiovascular disease," he added.
During the trial, the effects of diuretics, also known as "water pills", were compare to three other classes of blood pressure medications-including calcium channel blockers which relax blood vessels; ACE inhibitors that prevent the formation of a hormone which causes blood vessels to narrow; and alpha blockers that reduce nerve impulses that constrict vessels.
The researchers found that diuretics offered greater protection against cardiovascular disease including heart failure, and were at least as effective for lowering blood pressure.
"The newer medications tend to produce better glucose and cholesterol values but the diuretics tend to generate better patient outcomes," said Dr. Davis.
Compared with the diuretic, the calcium channel blocker, ACE inhibitor and alpha-blocker had higher rates of heart failure among patients with the metabolic syndrome, 7,327 blacks and 15,750 whites. The ACE inhibitor and the alpha-blocker also had an increased risk of combined cardiovascular disease.
Dr. K. Lance Gould, professor in the Division of Cardiology at the UT Medical School at Houston, said: "This is an important study that provides a new insight into diuretic therapy for blood pressure control, particularly in patients with the metabolic syndrome who are subject to heart failure."
He further said: "While the primary endpoint showed no difference between drug treatment groups, subset analysis of the metabolic syndrome showed less heart failure when diuretics are used. This subset analysis emphasizes the value of diuretic treatment in patients with the metabolic syndrome who are subject to heart failure."
The study titled 'Clinical Outcomes by Race in Hypertensive Patients With and Without the Metabolic Syndrome' has been published in the Archives of Internal Medicine, one of the JAMA/Archives journals.