Lowering Blood Pressure the Old-Fashioned Way

Experts in high blood pressure are recommending a switch back to the basics.

Gone is the trend toward new, high-blood-pressure medications with fancy names and high prices. Instead, the new national guidelines recommend that doctors treating high blood pressure first prescribe diuretics and beta blockers, two of the oldest classes of medication used for the problem.

Because they “have been shown to reduce cardiovascular deaths and disability in controlled clinical trials, these two classes of drugs are preferred for initial therapy,” said Ray W. Gifford Jr., who chaired the committee of university researchers and National Institutes of Health scientists who made the new recommendations.

The newer drugs--the fruits of high technology with such strange sounding names as calcium channel blockers, angiotensin and converting enzyme inhibitors, alpha-1 receptor blockers and the alpha-beta blockers--are equally effective in controlling high blood pressure, the committee found.

But these drugs often cost a lot, as much as 30 times more than generic brands of diuretics--which reduce fluids in the body--and beta blockers--which act on the nervous system to help reduce blood pressure.

The newer types of blood-pressure medication also don’t have a long-term record. No one knows for sure what, if any, the effects of years of use may be.

For this reason, Gifford said, they should be reserved for special, hard-to-treat cases or for situations when the other drugs are “unacceptable or ineffective.”

But doctors also need to consider the race of their patient when prescribing blood-pressure medication, the committee noted in its report.

Studies have shown, for example, that blacks respond better to diuretics and calcium channel blockers than to beta blockers or to ACE inhibitors.

Older people with high blood pressure “are generally responsive to all classes of drugs,” according to the report.