Antihypertensive Meds: Equivalence Unveiled in Long-Term Study
It turns out that three common classes of antihypertensive medications - chlorthalidone, calcium channel blockers (CCBs), and angiotensin-converting enzyme (ACE) inhibitors - exhibit similar efficacy in the long run when it comes to reducing cardiovascular disease-related mortality. This intriguing finding stems from a secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
According to researchers led by Jose-Miguel Yamal from the University of Texas Health Science Center in Houston, the mortality rate due to cardiovascular disease after a 23-year follow-up was consistent across all three medication groups. The groups included patients treated with chlorthalidone, a diuretic; CCBs, such as amlodipine; and ACE inhibitors, like lisinopril.
The ALLHAT study was a landmark investigation into treating high blood pressure, involving over 42,000 participants aged 55 or older who had either moderately elevated blood pressure or one or more cardiovascular risk factors. The results showed that none of the medication types was inherently superior to the others and that there were no surprising risks associated with a specific active ingredient after an extended period.
The current study builds upon the ALLHAT trial, seeing as some participants were followed for over two decades after the trial's commencement. The researchers utilized medical records from the American Medicare health service to track patients' deaths, with around 80% having already passed away by the end of the follow-up period.
While these results are fascinating, one point that merits scrutiny is the 19% increase in stroke risk observed in the lisinopril group versus the chlorthalidone group, which the researchers promptly dismissed as potentially being due to chance. Critics, such as Roland Schmieder of Erlangen University Hospital, argue that this result should not be highlighted in the article, as there is no reliable scientific evidence to support the notion that ACE inhibitors heighten the risk of stroke.
Understandably, lifestyle changes play a key role in blood pressure management. A healthy diet, quitting smoking, and regular exercise are all fundamental to lowering blood pressure, with lifestyle modifications being similar to medication in terms of importance and effectiveness. The earlier these lifestyle changes are implemented and the more sensibly blood pressure is adjusted, the better.
What sets this study apart is the revelation that not only dynamic sports but also isometric exercises, like tension training in the gym, can lower blood pressure. When it comes to alternative methods, however, it's crucial not to disregard medication in favor of diet and exercise, as effectively controlling blood pressure is vital.
The effectiveness of different medications can vary among individuals, with some patients achieving lower blood pressure with one drug than another. This discovery constitutes a golden opportunity for personalized medicine, allowing doctors to prescribe medications that best align with patients' pre-existing conditions or that they can tolerate most effectively.
