A good ol' cheap drug is just as effective as the newer, sexier, expensive drugs as a first step in controlling high blood pressure, according to investigators reporting at the annual American Heart Association meeting in Orlando, FL.

Since the patent has expired on the older drug (chlorthalidone, a diuretic or "water pill"), there are no attractive and affable pharmaceutical representatives pushing it in doctors' offices, handing out free pens, sticky note pads, and other tchotchkes.

The U.S. Food and Drug Administration is in charge of approving availability of drugs as long as they are "safe and effective."  If a drug lowers high blood pressure and is safe, it's going to be approved.  But just because a drug lowers blood pressure doesn't necessarily mean that it reduces death rates and disability associated with high blood pressure.  That's much harder to prove, and it's not required by the FDA. 

The massive ALLHAT study began in 1994 and involved more than 42,000 older men and women with high blood pressure who were starting their first blood pressure pill.  Investigators wondered whether some drugs would be more effective than others at reducing death rates, heart attacks, heart failure, and strokes. 

Study participants were randomized to recieve either chlorthalidone, amlopdipine (e.g., Norvasc), lisinopril (e.g, Prinivil, Zestril), or doxazosin (e.g., Cardura). 

At both five and 10 years after the study began, researchers looked at health outcomes, with attention to death rates, strokes, heart attacks, and heart failure.  They concluded that, overall, the chlorthalidone is at least as good as, if not better than, then newer, much more expensive agents. 

If and when I'm diagnosed with high blood pressure, all other things being equal, I'm asking my doctor for chlorthalidone.

For a non-drug method of blood pressure control, consider the DASH Diet.

-Steve Parker, M.D.

PS: The market-leading thiazide diuretic used for high blood pressure is hydrochlorothiazide.  It's similar to chlorthalidone, but not the same.  Is it just as good?  Nobody knows.  I'm asking for chlorthalidone. 

Reference:  Jeffrey, Susan.  ALLHAT investigators report 10-year follow-up and stand by diuretics as first step antihypertensive treatment.  HeartWire, November 19, 2009.