News
Newer Drugs for Hypertension in Metabolic Syndrome, ACE inhibitor Lisinopril
Diuretics proved equal or superior to newer, more costly drugs in preventing adverse cardiovascular or renal outcomes for hypertensive patients with metabolic syndrome, a study found.
This was particularly true for black patients, especially for end-stage renal disease, heart failure, and stroke, Jackson T. Wright Jr., M.D., Ph.D., of Case Western Reserve University, and colleagues reported in the Jan. 28 issue of Archives of Internal Medicine.
The findings came from a subgroup analysis of a large trial for thiazide-type diuretics versus calcium channel blockers, alpha-blockers, or angiotensin-converting enzyme (ACE) inhibitors.
The findings failed to support the current preference for the newer drugs, despite their more favorable metabolic profiles, Dr. Wright said.
Despite the lack of supportive clinical outcome data, antihypertensive drugs with a favorable metabolic profile (lowering blood sugar and cholesterol) are still used as first-line therapy in hypertensive patients with metabolic/cardiometabolic syndrome, the researchers wrote.
To analyze clinical outcome data, including the role of race, the researchers undertook a subgroup analysis of the earlier Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) trial.
ALLHAT was a randomized, double-blind trial of 42,418 hypertensive patients, 55 and older, who had at least one other component of the metabolic syndrome.
The patients were randomized to a thiazide-type diuretic (chlorthalidone), a calcium channel blocker (amlodipine), an alpha-blocker (doxazosin [Cardura]), or an ACE inhibitor (lisinopril).
Patients were followed for a mean 4.9 years, with the exception of those in the alpha-blocker group, which was terminated early because of increased rates of cardiovascular disease.
The current sub-analysis focused on the effects of treatment, by race, on cardiovascular and renal outcomes in patients having at least two components (rather than one) of the metabolic syndrome.