I have copied parts of the results of this government sponsored trial, and pasted it here. It appears that some antihypertensive medications were associated with heart failure/complications. I take ace inhibitors myself, and will be talking to my doctor. The entire page that I copied this from is here
http://www.nhlbi.nih.gov/new/press/02-12-17.htm
ALLHAT Trial
Less costly, traditional diuretics work better than newer medicines to treat high blood pressure and prevent some forms of heart disease, according to results from the largest hypertension clinical trial ever conducted. The long-term, multi-center trial, which was supported by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, compared the drugs for use in starting treatment for high blood pressure.
Findings of the "Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial," or ALLHAT, appear in two articles in the December 18, 2002, issue of The Journal of the American Medical Association.
"ALLHAT was conducted in a variety of practice settings and included many primary care clinics," said Dr. Barry Davis, Director of the ALLHAT Clinical Trials Center and Professor of Biometry at the University of Texas-Houston Health Science Center. "It also included high proportions of women, seniors, minorities, and those with type 2 diabetes. Thus, the high blood pressure results add crucial information about how well such patients do on the different drugs."
The ALLHAT blood pressure study was a randomized, double-blind trial. It involved 42,418 participants aged 55 and older, and was conducted at 623 clinics and centers across the United States and in Canada, Puerto Rico, and the U.S. Virgin Islands. About 7,000 US veterans participated in the study through 69 Department of Veterans Affairs clinics.
Participants were randomly assigned to receive one of four drugs–a diuretic (chlorthalidone); a calcium channel blocker (amlodipine); an angiotensin converting enzyme (ACE) inhibitor (lisinopril); and an alpha-adrenergic blocker (doxazosin). They received additional antihypertensive drugs if their doctor thought it necessary to control their blood pressure.
The alpha-adrenergic blocker arm of the study was stopped in March 2000 because those on the drug had 25 percent more cardiovascular events and were twice as likely to be hospitalized for heart failure as users of the diuretic.
All three classes of drugs reported on in the December 18 issue of JAMA — diuretics, calcium channel blockers, and ACE inhibitors — have been previously shown to lower blood pressure and reduce cardiovascular complications. In head-to-head comparisons, the diuretics were shown to be superior in treating high blood pressure and preventing cardiovascular events.
As reported in JAMA, after about 5 years of followup, compared to participants who were taking the diuretic, those on the calcium channel blocker had —
On average, about a 1 mm Hg higher systolic blood pressure
38 percent higher risk of developing heart failure and 35 percent higher risk of being hospitalized for the condition
Compared to participants who were taking the diuretic, those on the ace inhibitors had
On average, about a 2 mm Hg higher systolic blood pressure–and 4 mm Hg higher in African Americans
15 percent higher risk of stroke
40 percent higher risk of stroke for African Americans
19 percent higher risk of developing heart failure
11 percent greater risk of being hospitalized or treated for angina (chest pain)
10 percent greater risk of having to undergo a coronary revascularization (such as coronary artery bypass surgery)
"The take-home message is that doctors should begin drug treatment for high blood pressure with a diuretic," said Dr. Paul Whelton, Senior Vice-President for Health Sciences at Tulane University in New Orleans, LA, and an ALLHAT Regional Coordinator. "A great majority of patients can tolerate a diuretic but, for those who can't, then a calcium-channel blocker, an ACE-inhibitor, or a beta blocker may be used to start treatment.
"ALLHAT's findings also indicate that most patients will need more than one drug to adequately control their blood pressure, and one of the drugs used should be a diuretic," he continued.
"Those who are now on a calcium channel blocker or an ACE inhibitor or another hypertension drug besides a diuretic should not stop taking their medication," he added. "But they should certainly talk with their doctor about adding or switching to a diuretic for their treatment."
"ALLHAT's findings refine the current clinical guidelines that recommend starting therapy for hypertension with a diuretic or a beta blocker," said Dr. Jeffrey Cutler, NHLBI Senior Advisor. "The new findings will allow doctors to achieve better blood pressure control and, more importantly, better cardiovascular health for their patients. And, it will do this at a more affordable price for their patients.
"I want to stress," he continued, "that people should not stop or change their blood pressure-lowering medication on their own. They should talk with their doctor about the treatment that's best for them."
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