Should hypertension be treated with angiotensin-converting-enzyme inhibitors, calcium-channel blockers or diuretics?
Kathryn A. Myers Division of Infectious Diseases Queen’s University Kingston, Ont. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) [erratum appears in JAMA 2003; 289(2):178]. JAMA 2002;288(23): 2981-97. Background: Over the past decade, newer and more expensive antihypertensive drugs, such as calcium-channel blockers and angiotensin-converting- enzyme (ACE) inhibitors, have become common first-line therapy for hypertension. Although newer antihypertensive medications have proven benefit in lowering both blood pressure and the rate of cardiovascular events, few large clinical trials have compared them with diuretics. Question: Does antihypertensive therapy with calcium-channel blockers or ACE inhibitors lower the incidence of cardiovascular disease more than treatment with a diuretic? Design: This very la
