Practical Practitioner

By: Pamela Egan, FNP-C CDE

Diuretics are best choice in treating hypertension (high blood pressure)

There’s a lot of talk these days about which drug to use for the initial treatment of hypertension (high blood pressure). Years ago, most patients got a diuretic first. Now ACE inhibitors or calcium channel blockers are often started first. The question of which drug to use, was reviewed a few months ago with the National Institute of Health’s huge ALLHAT hypertension study. It surprised many experts by suggesting diuretics are the best choice.

ALLHAT shows that the diuretic chlorthalidone, the ACE inhibitor lisinopril, and the calcium channel blocker amlodipine are equally effective for preventing MI’s and coronary death.

But the chlorthalidone may be more effective than amlodipine or lisinopril for preventing heart failure, and more effective than lisinopril for preventing stroke. Most patients will need at least two drugs to control BP. The important point is that if a diuretic is not started first, it should definitely be added as the second drug.

ACE-inhibitors should be used for patients with diabetes. An ACE inhibitor or beta-blocker should be used post heart attack, a beta-blocker or calcium channel blocker for angina.

Patients are seeing lots of ads for anti-aging supplements that appear to contain growth hormone. There are lots of tempting names – Nature’s Youth HGH; Symbiotropin HGH; HGH Activator; Youngevity HGH; etc. – but these products don’t contain any growth hormone at all. Most contain only amino acids.

Manufacturers call these amino acids “growth hormone releasers.” They suggest that these amino acids stimulate the pituitary gland to release growth hormone. It’s true that some amino acids have a role in growth hormone production.

But there’s no reliable evidence these amino acids increase growth hormone, and no proof that growth hormone helps to prevent aging. Don’t waste your money.

This article was originally published April 21, 2003 in The St. Tammany News.

PamelaEgan.com > Health Articles > Heart Disease