Diuretics best for high BP and metabolic syndrome

Diuretics are helpful in reducing heart disease among patients with metabolic syndrome and high blood pressure. American researchers studied 23,077 people (7,327 blacks and 15,750 whites) with both high blood pressure and metabolic syndrome, a cluster of risk factors for heart disease. During the trial, the effects of diuretics, also known as "water pills", were compared to three other classes of blood pressure medications — including calcium channel blockers which relax blood vessels; ACE inhibitors that prevent the formation of a hormone which causes blood vessels to narrow; and alpha blockers that reduce nerve impulses that constrict vessels. It was found that diuretics offered greater protection against cardiovascular disease including heart failure, and were at least as effective for lowering blood pressure as other medicines. The newer medications tend to produce better glucose and cholesterol values but the diuretics tend to have better patient outcomes. Compared with the diuretics, the calcium channel blockers, ACE inhibitors and alpha-blockers had higher rates of heart failure among patients with the metabolic syndrome. The ACE inhibitors and the alpha-blockers also had an increased risk of combined cardiovascular disease. The results showed that blacks, who had a high incidence of high blood pressure, were particularly likely to derive the heart benefits connected with diuretics. The findings also provide an insight into diuretic therapy for blood pressure control, particularly in patients with the metabolic syndrome who are subject to heart failure. Although the outcomes showed no difference between drug treatment groups, subset analysis of the metabolic syndrome showed less heart failure when diuretics are used. This underscores the value of diuretic treatment in patients with the metabolic syndrome who are prone to heart failure.