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Antihypertensive drugs, myocardial infarction and stroke

Author : Pierre Allain Date : 2010-1-30

Antihypertensive drugs decrease the adverse effects of arterial hypertension. But very often only one antihypertensive is not enough to control hypertension. When two drugs are necessary, one of them is often a diuretic.

A paper published in the BMJ, January 2010, studies the frequency of myocardial infarctions and strokes according to the type of antihypertensive used in combination with a diuretic: angiotensin-converting-enzyme inhibitor, ACE inhibitor, or angiotensin receptor blocker, sartan, or beta blocker or calcium channel blocker. The risk of myocardial infarction and stroke, compared to that of the combination diuretic plus beta blocker, is reduced approximately but not significantly by 25% by the combination diuretic plus ACE inhibitor or sartan but was doubled by the combination diuretic plus calcium channel blocker. Regarding the risk of myocardial infarction, compared to the combination diuretic plus beta-blocker, the combination diuretic plus ACE inhibitor or sartan gave better results, whereas the association diuretic plus calcium channel blocker gave worse results Regarding the risk of stroke, the combination diuretic plus ACE inhibitor or sartan was more effective than the combination diuretic plus beta-blocker, and the combination diuretic plus calcium channel blocker and the combination diuretic plus calcium channel blocker gave approximately the same results.

It is not sure that the same results would be obtained with all the drugs of the same group but on the whole these results lead to disadvise the combination of a diuretic and a calcium channel blocker. Thus, there is no commercial preparation combining a diuretic with a calcium channel blocker, whereas there are many combining a diuretic and an ACE inhibitor, a sartan or a beta blocker

For more information, see ACE inhibitors, sartans, beta-blockers and calcium-channel blockers.


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