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 lowering blood pressure by any means is important in reducing the risk for heart attack and stroke.
"Patients with hypertension are at increased risk for heart attacks and strokes, and reducing blood pressure to goal levels is essential to lower this risk," Fonarow said. "Clinicians and researchers continue to debate whether there are important differences among the specific medications in reducing risk."
These two studies involved pooling together different randomized trials to explore the relative differences for coronary heart disease and stroke risk with different classes of antihypertensive agents, Fonarow said.
"Despite the large number of studies and patients, due to differences in the on-treatment blood pressures achieved in the various studies, something which was not controlled for in these analyses, no firm conclusions can be drawn," Fonarow said. "Furthermore, recent large scale randomized clinical trials where similar blood pressures have been achieved provide entirely different conclusions."
"Achieving and maintaining control of blood pressure to goal levels with lifestyle changes and, when indicated, anti-hypertensive medications is far more important than which specific anti-hypertensive medication is selected," he said.
For more on heart disease and stroke, visit the American Heart Association.
SOURCES: William J. Elliott, M.D., Ph.D., professor, preventive medicine, internal medicine and pharmacology, Rush Medical College, Chicago; Gregg C. Fonarow, M.D., professor, cardiology, University of California, Los Angeles; May 6, 2009, presentations, American Society of Hypertension annual meeting, San Francisco