I just happened across this today. Funny thing, an endocrinologist told me last week I should consider a diuretic, as my high blood pressure was not responding to my meds. ---Karen Diuretics Best Against High Blood Pressure Tue Dec 17, 3:40 PM ET Add Science - Reuters to My Yahoo! By Maggie Fox, Health and Science Correspondent WASHINGTON (Reuters) - Older and cheaper diuretic drugs, also known as water pills, work as well as and often better than newer and more expensive drugs in fighting high blood pressure, U.S. doctors reported on Tuesday. Patients newly diagnosed with high blood pressure should start taking a diuretic to see if it works, and only add drugs such as ACE inhibitors or beta-blockers if their blood pressure needs to be lowered further, the researchers said. Their study of more than 40,000 men and women with high blood pressure is the largest to date. Most trials of pressure-lowering drugs have tested them against placebo -- and all the licensed drugs work better than taking a dummy pill. "(The trial) shows that diuretics are the best choice to treat hypertension and reduce the risks of its complications, both medically and economically," Dr. Claude L'Enfant, director of the National Heart, Lung and Blood Institute, told a news conference. Diuretics lower blood pressure by ridding the body of excess water, often making patients urinate more often. In 1982 they were prescribed in 56 percent of the cases of high blood pressure treated by drugs, but in 1992 they were prescribed in only 27 percent of the cases. "Many of the newer drugs were approved because they reduce blood pressure and the risk of heart disease compared with a placebo. But they were not tested against each other," L'Enfant said. "Yet these more costly medications were often promoted as having advantages over older drugs, which contributed to the rapid escalation of their use." L'Enfant, whose institute sponsored the trial, published in the Journal of the American Medical Association (news - web sites), said the findings were good news for patients and insurers. Between 1982 and 1992, patients and insurers could have saved an estimated $3.1 billion treating high blood pressure if they had stuck with diuretics instead of flocking to use the new drugs. Fifty million Americans, and 200 million to 300 million people worldwide, have high blood pressure, which is the No. 1 risk factor for heart disease and heart failure. BILLIONS SPENT ON DRUGS About 24 million Americans take drugs to lower their blood pressure, at an estimated cost of $15.5 billion a year. Dr. Barry Davis of the University of Texas said diuretics cost between 6 cents and 10 cents a day, compared to $1.60 for a beta-blocker and up to $1.46 a day for an ACE inhibitor. The trial, which included white, black and Hispanic men and women, separated patients into three groups. They received either the diuretic chlorthalidone, which is available generically; the calcium channel blocker or beta-blocker amlodipine, sold by Pfizer Inc. as Norvasc; or the ACE inhibitor lisinopril, sold by AstraZeneca as Zestoretic. All the drugs lowered blood pressure and reduced the risk of heart attack and other "events" such as severe chest pain. "In head-to-head comparisons, the diuretics were shown to be superior in lowering blood pressure and preventing cardiovascular events," L'Enfant said. Experts said no one taking blood pressure drugs should change what he or she is doing without consulting a doctor. "Those who are now on a calcium channel blocker or an ACE inhibitor or another hypertension drug besides a diuretic should not stop taking their medication," said Dr. Paul Whelton of Tulane University in New Orleans, one of the researchers. "But they should certainly talk with their doctor about adding or switching to a diuretic for their treatment." The study included a comparison of Bristol-Myer Squibb's cholesterol lowering drug Pravachol, known generically as pravastatin, to "best" treatment for high cholesterol. Researchers said the results were unclear but supported the idea that patients with high blood cholesterol should diet, exercise and, if necessary, take drugs, including statins such as Pravachol, to control levels. A low-salt, low-fat diet and exercise is also the first line of treatment for high blood pressure.