Water Pills: Mother Knew Best

If you're one of the 24 million Americans taking high blood pressure medication, a new government-sponsored study suggests that old-fashioned, inexpensive diuretics are much more effective at treating the condition than most of the newer, pricier drugs that are often prescribed. The Early Show medical correspondent Dr. Emily Senay reports.

The long-awaited study released Tuesday started in 1994. Researchers had a simple question: of all the medications out there, which works best to lower high blood pressure and reduce the risk of cardiovascular complications like heart attack, stroke, heart failure, said Dr. Senay.

It compared the generic diuretic chlorthalidone with two newer, more expensive blood pressure treatments, the ACE inhibitor lisinopril and the calcium channel blocker amlodipine.

The findings show a slightly greater percentage of patients got their blood pressure below 140/90, which was the goal of the study, when they used the diuretic compared to the two newer medicines.

Researchers also found the diuretic was better than the calcium channel blocker in preventing heart failure and better than the ACE inhibitor in preventing stroke, heart failure and chest pains.

A third blood pressure drug, the alpha blocker doxazosin, was dropped from the study more than two years ago because it proved significantly less effective than diuretic treatment.

The study mostly founded by the National Heart, Lung, and Blood Institute and published in the Journal of the American Medical Association, followed 33,357 patients, age 55 and older, from 623 sites in the United States, Canada, Puerto Rico and the U.S. Virgin Islands. Researchers found that the old -fashioned water pill, the kind your grandmother took years ago, works better than these newer, fancier medications at reducing high blood pressure and the chance of complications, said Dr. Senay.

"The hope is that we make it easier for both providers and patients to achieve blood pressure control using the most effective, as well as least costly, medication," said Dr. Jackson T. Wright Jr. of Case Western Reserve University and vice chairman of the study's steering committee.

Diuretics might be excellent therapy for some, but not all patients can take them, noted Dr. David A. Meyerson, a Johns Hopkins University cardiologist and American Heart Association spokesman who was not involved in the research.

The study was part of a clinical trial that also looked at cholesterol lowering in patients with high blood pressure. The cholesterol study covered 10,355 patients from the more than 42,000 people recruited for the blood pressure study.

In the second study, also sponsored by the government institute, the cholesterol-lowering drug pravastatin was compared to usual care given to patients, which typically meant a low-cholesterol diet.

However, as the study progressed, more patients in the usual care group began taking the cholesterol-lowering medications, called statins, because their conditions warranted it.

Those taking pravastatin reduced total cholesterol by 20 percent after six years, while the usual care group saw total cholesterol decline 11 percent. But the difference between groups might have been greater had some of the usual-care patients not started taking statins, said Dr. Barry R. Davis of the University of Texas School of Public Health in Houston and director of the study's clinical trials center.

Other research has shown that statins, specifically pravastatin, can reduce deaths from heart disease. When diet and lifestyle changes don't work in lowering cholesterol, patients should consider going on a statin drug to reduce their cholesterol, Davis said.