Norvasc plus ACEi much better than Atenolol plus HCTZ

So much about ALLHAT... In this new study of 20,000 patients, Norvasc plus ACEi was so much better (15-25%) than Atenolol plus HCTZ that the study had to be stopped early (the study was sponsored by Pfizer). The beta-blocker plus diuretic combination also increased the risk for DM2 by 30%.

This looks like an example of Tamhane's law which postulates that doctors often run like a flock of sheep in the opposite direction of the latest guideline after each new "landmark" study.

ALLHAT --------------------------> HCTZ
CCB and ACEi <----------------- New study

Note: Dr. Tamhane was a third year resident at CWRU (St.Vincent/St.Luke) and is a currently a geriatrics fellow.

A study published in the Jan 2008 edition of Archives of Internal Medicine "failed to provide support for the selection of alpha-blockers, ACEi, or CCB over thiazide-type diuretics to prevent cardiovascular problems in patients with metabolic syndrome."

References:
Hypertension and ethnic group. Morris J Brown. BMJ 2006;332:833-836 (8 April)
New Debate on Some Blood Pressure Drugs. WebMD Medical News, 01/2008.
Image source: Platoon Drill. Mark_Twells' photostream. Creative Commons license.

Updated: 01/28/2008