In addition, this study may help end the debate about which diuretics are best. Elliott's group found that there was no difference among different diuretics in preventing heart attack or sudden cardiac death.
"We presume the lack of significance with ARBs stems from the fact that this is the newest class of drugs, and therefore fewer trials involving fewer patients having fewer coronary heart disease events [half to a third of other classes] limits the statistical power of the analysis," Elliott said.
In the second report, Elliott's team analyzed 60 clinical trials involving 279,371 patients. In their analysis, the researchers also found that blood pressure-lowering drugs were significantly better than placebo or no treatment in reducing the risk of stroke.
Starting treatment with a diuretic reduced the risk of stroke by 55 percent, while beta blockers reduced the risk by about 22 percent, and ACE-inhibitors reduced the risk by about 16 percent. Starting treatment with a diuretic, ARB or calcium channel blocker did not produce significantly different results, the researchers added.
As with the other analyses, there was no significant difference between diuretics in preventing stroke.
"All antihypertensive drug classes are significantly better than placebo/no treatment to reduce the risk of stroke," Elliott said.
Although there are some differences in stroke prevention between the different antihypertensives, the data suggest that diuretics and calcium channel blockers may be more effective in preventing stroke than heart attack.
Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, does not think these studies answer the question of which blood pressure medication is best. The bottom line is that lower
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