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Score Another Point for Diuretics as Most Effective Hypertension Treatment
by Pam Chwedyk Minority Nurse Writer
In 2002, the landmark Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the largest and most racially/ethnically diverse clinical study to date comparing the effectiveness of different hypertension treatments, made counterintuitive history. Contrary to popular belief, the study found that traditional, less costly diuretics actually work better than newer classes of drugs--such as calcium channel blockers, ACE inhibitors and alpha-blockers--in lowering blood pressure and preventing some forms of cardiovascular disease (CVD).
Despite this dramatic finding, current medical practice continues to favor the use of these new, more expensive medications to treat high blood pressure in patients who have metabolic syndrome--a group of conditions, such as high cholesterol, diabetes and hypertension, that increase a person’s risk of developing CVD. But now, the latest results from the long-term ALLHAT study, which is sponsored by the National Heart, Lung and Blood Institute (NHLBI), strongly suggest that the most effective treatment for people who have high blood pressure as part of metabolic syndrome is--once again--diuretics.
In this new phase of the study--in which about 35% of the participants were African American--the researchers compared a diuretic (chlorthalidone) with a calcium channel blocker (amlodipine besylate), an ACE inhibitor (lisinopril) and an alpha-blocker (doxazosin mesylate). Each drug was used to start treatment and other medications could be added if necessary to control blood pressure. The findings, published in the January 28 issue of Archives of Internal Medicine, indicate that for patients with metabolic syndrome, diuretics offer greater protection against CVD, and are at least as effective in lowering blood pressure, than the newer, less affordable medicines.
“These findings are particularly important for patients with metabolic syndrome because many doctors currently prescribe [these new classes of drugs] due to their more favorable short-term effects on blood sugar and blood cholesterol levels,” says Elizabeth Nabel, MD, director of NHLBI. “However, this new analysis shows that diuretics are better at preventing CVD and thus it does not support the selection of the newer drugs over diuretics for preventing poor health outcomes related to hypertension or for lowering high blood pressure.”
This is especially good news for African Americans, who have the highest CVD mortality rates of any racial minority group in the U.S. “In black patients with high blood pressure and metabolic syndrome, the evidence from ALLHAT overwhelmingly supports the choice of thiazide-type diuretics,” says the report’s lead author, Jackson Wright, Jr., MD, PhD, of Case Western Reserve University. For example, when compared to those taking diuretics, black ALLHAT participants receiving ACE inhibitors had poorer blood pressure control and a 24% greater risk of overall CVD, including a 19% higher risk of coronary heart disease, a 37% higher risk of stroke and a 49% greater risk of heart failure.
Racial and Ethnic Disparities Common in Treatment of Rare Cancer
By now it’s become common knowledge that Americans of color face severe disparities in incidence rates, treatment and survival when it comes to the most common types of cancer--e.g., cancers of the breast, lung, prostate and colon. But what’s less well known is how racial and ethnic minority populations are affected by rarer, less common forms of the disease. Now, however, cancer researchers are beginning to turn their attention to this question. And they’re finding that here, too, the playing field is far from level.
A first-of-its-kind study conducted by researchers in California has found that significant racial and ethnic differences exist in the treatment and outcomes of patients with extremity soft-tissue sarcomas, a rare but dangerous cancer that begins in muscle, fat, blood vessels or other supporting tissue of the body. While the disease can sometimes lead to amputation of the affected arm or leg, the standard treatment is a combination of radiation therapy and limb-preserving surgery. In fact, in about 90% of cases, patients can be treated effectively without having to lose their limb.
However, the study’s findings, published in the March 1 issue of the American Cancer Society’s journal CANCER, reveal that amputation is much more likely to be physicians’ treatment of choice when patients are African American or Hispanic. Black patients in particular had significantly lower rates of limb-saving surgeries compared to other racial/ethnic groups, had the highest rates of amputation and were least likely to receive additional treatments that would lead to improved survival. As a result, black patients were 39% more likely to die from their disease than their white counterparts.
The researchers, led by Dr. Steve Martinez of the University of California Davis Cancer Center, also found that Hispanics tend to be diagnosed with extremity soft-tissue sarcomas at a younger age than other ethnic groups, and that blacks, Hispanics and Asians tended to have larger tumors than Caucasians. “[The medical profession] needs to focus our efforts toward improving extremity soft-tissue sarcoma treatment and outcomes for all patients, especially for those most at risk,” Martinez concludes.