They all actually perforrm about equal. It really depends on the problem of the individual and what side-effects are bothersome for that person. Depending on the population group chosen for any given study, you can show superiority for any given drug.
Diuretics were selected as the "recommended" class in this huge ALLHAT study. Because of this big study, the JNC guidelines were updated to recommend this as the preferred class of drugs. However, an Australian trial (ANBP2) found ACE inhibitors to be superior to diuretics. One big difference between the two trials was that the ALLHAT had a 35% black population. ANBP2 was almost purely caucasion.
Generally speaking, blacks (low renin) tend to respond better to diuretics and CCBs for the initial drug choice. Whites (high renin) tend to respond better to ACEI, ARBs and Beta-Blockers. But, again, this is just racial profiling. And, not all whites are high renin and vice versa.
The problem with the high renin group, is that there is a kidney feedback mechanism that is kicking in to counteract the lowering of BP. So, if a high renin person takes a diuretic (or goes on a low-sodium diet), the kidneys detect this and produce renin. This activates the angiotensin system causing vasoconstriction. In many individuals, this response can actually result in HIGHER BP. In other words, these individuals might do better to eat more salt! The best drugs for blocking this response are the ACEIs and ARBs. And, once this response is blocked, these individuals will now respond to any of the classes of drugs (and a low-sodium diet). Another way of thinking about it is that the ACEIs and ARBs convert a high-renin person into a very very low-renin person.
Pal, what is renin? I am black, female, 52 with diabetes. you say that blacks are low renin, so what does that mean. I have tried all classes of bp meds and the only one that lowers my bp to acceptable levels would be ace inhibitors. Unfortunately im allergic. I like the hctz but it causes my glucose levels and cholesterol levels to rise.
JTU, I was just wondering how you are doing with your no smoking attempt.I truly hope that you are still hanging in there. It was the most difficult thing I had to do, but it will get better with each passing day. Good luck
Pal, what is renin? I am black, female, 52 with diabetes. you say that blacks are low renin, so what does that mean. I have tried all classes of bp meds and the only one that lowers my bp to acceptable levels would be ace inhibitors. Unfortunately im allergic. I like the hctz but it causes my glucose levels and cholesterol levels to rise.
Renin is an enzyme that is produced by your kidneys. Your kidneys produce this in response to a low sodium and/or low volume (BP) situation. This enzyme converts angiotensinogen (produced in the liver) into angiotensin I. ACE then converts angiotensin I -> II. And, angiotensin II then causes vasoconstriction (BP goes up). Your ACE inhibitor blocks the conversion of angiotensin I into II, thus breaking this cycle. At least that's the science behind this.
When I said blacks are low renin, I mean that a higher percentage of blacks fall into that catagory. This doesn't mean that all blacks are low renin and all whites are high renin. Obviously, everyone has a different response. There is a test for this (PRA). But, it appears to be require a very specialized sodium controlled diet for a few days.
A very interesting article on this can be found at: http://www.stress.org/Hypertension.htm
Bharkins, thanks for your concern. I need it. I need all the help and prayers i can get. I am still not smoking, but it is a great temptation. Especially since I don't work and a lot of stress is coming my way. I find that taking my walks helps alot with the stress. My husb. still smokes and sometimes I feel like asking for one of his cigs. I know my bp is connected to smoking though, so i won't smoke.
Thanks Pal. I will read the article. How will i know if im high or low renin? I eat a low sodium diet.
The fact that you are getting a good response from an ACEI suggests that you may be high renin. Of course, a low sodium diet will greatly boost the effect of an ACEI.
As far as smoking is concerned, I wouldn't worry about BP. I'd worry more about the lung cancer. My wife's mom died of that. And, that has to be the absolute worst way to go... especially when it had metastasized to her brain.
That is the great thing about B/P meds. My blood tests were fine, except my glucose was slightly elevated at 103. I'm 5' 11" 150 & eat no sweets. It's great putting people on meds. that cause all sorts of side-effects & raise glucose & cholesterol..... Make sense.
JTU,
I am so happy for you and I know first hand what a struggle quitting is.
My husband was still smoking when I quit ( it took a heart attack to make him quit ) and living with that temptation was so difficult.
Again I am so proud of you and will still keep you in my prayers!
Pal, I agree with you about lung cancer I watched my mom die from it when I was only 16. Something I will never forget!
Cass
