Reducing high blood pressure with inexpensive diuretics
According to the American Heart Association, more than 40 percent of non-Hispanic blacks have high blood pressure. Not only is hypertension more severe in blacks than whites, it also develops earlier in life. The theory is that perhaps it may be due to higher fat and sodium dietary content in the population. Also researchers have found that there may be a gene that makes African-Americans much more salt sensitive. This trait increases the risk of developing hypertension. In people who have this gene, as little as one half a teaspoon of salt could raise your blood pressure. Treating hypertension early and correctly, in a method that allows for high compliance is crucial. Prescribing the newest and greatest medication will not be helpful if it is not affordable to stay on it.
A research study earlier this year of more than 600 black patients with uncontrolled hypertension found that less than half were prescribed a diuretic drug with proven benefits and minimal costs. This was according to researchers at Weill Cornell Medical College and the Visiting Nurse Service of New York's (VNSNY) Center for Home Care Policy and Research.
Their study, reported in the American Journal of Hypertension, found that the patients in the study who used common diuretic drugs had, on average, lower blood pressure than the patients who did not receive them.
"We were surprised to find that this beneficial and low-cost drug was not being prescribed for more patients who would benefit from it," says the study's lead investigator, Dr Linda Gerber.
Many earlier studies have shown that diuretics are particularly helpful in black patients with hypertension. They should be used as the first choice in treatment especially since newer and more expensive classes of medications have been shown to be less effective in the African American population. Newer drugs for hypertension include ACE inhibitors, ARB blockers and calcium channel blockers.
Diuretics, sometimes called water pills, help rid your body of salt and water. They work by making your kidneys excrete more sodium into your urine. The sodium, in turn, removes water with it from your blood. That decreases the amount of fluid flowing through your blood vessels, which reduces the blood’s pressure on the walls of your arteries. This is the first line of anti-hypertensive therapy.
"Yet, we find that physicians are not using the drugs as they should in a population that is especially hard hit by high blood pressure, and who suffer greater prevalence, severity, organ damage and mortality from the disease compared to other groups," says Dr. Gerber.
It is felt that some physicians may worry about potential side effects of diuretics. Side effects such as changes in potassium or sodium levels can be monitored and easily treated. In a high risk population with uncontrolled hypertension, the benefit of treating with a diuretic far outweighs the risk of side effects. Also, as expected, newer medications are promoted much more aggressively than older drugs such diuretics. Physicians are often encouraged by the latest research articles to use the newest medications instead of sticking to the older proven formulas.
Take away message: These new findings should be taken as a serious wake-up call for physicians who treat African American patients with hypertension. If diuretics work very well in this population and are lower in cost, their use should be routine. If you or someone you know is of African American decent, it may be worth your time to have a dialogue with your doctor about adding a simple diuretic to the medication regime if appropriate.
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