Study Questions Fluid Pill Use For Blood Pressure Control

Kathleen Blanchard's picture
Blood Pressure Pills

Combining your blood pressure medication into one pill daily may be the safest way to keep your blood pressure under control, according to a new study. Diuretics or fluid pills are prescribed to many patients to lower blood pressure. According to a study published in the New England Journal of Medicine, patients who were given a combination of a calcium channel blocker and ACE inhibitor had better health outcomes than those given a fluid pill or diuretic.

The study participants given an ACE inhibitor and calcium channel blocker experienced less incidence of death from heart attack, stroke, heart failure and heart blockages that could lead to heart attack than those taking blood pressure medicine plus diuretic. The study was sponsored by Novartis, the manufacturer of benazapril, the drug used during the research. Read: Common Medications Provide Equal Blood Pressure Control.

The study included 11,506 patients with high blood pressure who were at risk for heart disease related events such as angina, stroke and cardiac resuscitation. They provided the patients either with a calcium channel/ACE inhibitor combination drug or with the drug benazapril (ACE inhibitor), plus a diuretic. They found that blood pressure control with combined medicine was safer for patients than adding a diuretic to treat blood pressure.

The entire study group had the same cardiac risks at the onset of the study. At the end of thirty-six months, the research ended. Patients who were treated without using a diuretic fared better by 2.2% in primary outcomes of death, non-fatal stroke, hospitalization for angina, cardiac arrest requiring resuscitation, heart attack, and revascularization procedures to open blockages of the arteries to the heart. Secondary outcomes included death from heart disease, stroke, and heart attack that did not result in death.

Comparing the two groups, only 522 people experienced one of the primary outcomes described when they were given the combination of ACE inhibitor and calcium channel blocker, versus 679 patients who received a diuretic plus benazapril. The results equate to a 19.6% reduction in the chances of having a stroke, heart attack, angina or cardiac arrest from using a combination drug that does not contain a fluid pill to control blood pressure.

The study participants were age 55 or older, and included both men and women.

How Blood Pressure Pills Work


Fluid pills work to control blood pressure by reducing fluid volume in the body. They increase the amount of urine we produce. Many fluid pills, or diuretics, also cause us to lose potassium and sodium, making it sometimes necessary to take extra medication, such as potassium chloride to maintain a balance of electrolytes in the body. When excess fluid is eliminated, less pressure is exerted against the walls of the blood vessels, lowering our blood pressure numbers. Fluid pills are inexpensive, making them a desirable addition to a patient's drug plan.

Calcium channel blockers work by blocking calcium from the walls of the blood vessels and heart. Calcium causes the blood vessels to narrow. Calcium channel blockers can also control irregular heart rate, in addition to decreasing heart rate. Recent studies show that increased resting heart rate can contribute to early death. (1)

ACE inhibitors, (angiotensin converting enzyme inhibitor) block the powerful chemical, angiotensin in the body. Angiotensin causes the blood vessels to narrow. Drugs that block the chemical allow the arteries to widen, decreasing blood pressure. A common side effect is a dry cough, which many patients find intolerable.

What The Study Means to Your Blood Pressure

If your blood pressure medication treatment has been successful, but the study concerns you, speak with your doctor. If you are newly diagnosed with high blood pressure, you will probably want to speak with your physician about the findings of the study.

Your doctor will discuss your lifestyle, diet and exercise habits and other risk factors to determine whether a combination of ACE inhibitor and calcium channel blocker is really best for you.

The new study clearly showed that using fluid pills combined with ACE inhibitor to control blood pressure might not be safe for everyone. Prevention of complications from high blood pressure is important to avoid hospitalization and improve life span.

(1) Jouven X, Empana JP, Escolano S et al. Relation of heart rate at rest and long-term (>20 years) death rate in initially healthy middle-aged men. Am J Cardiol

Resource: NEJM