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High Blood Pressure and Kidney Disease will Increase Risk for Heart Disease and Stroke - Diuretics Better than ACE Inhibitors

February 6th 2006

High Blood Pressure and Kidney Disease will Increase Risk for Heart Disease and Stroke - Diuretics Better than ACE Inhibitors and Calcium Channel Blockers

Dr. Rahman

Older Americans with severe chronic kidney disease are more likely to develop heart disease than people with normal kidney function.  According to new research published in the Fed. 7th issue Annals of Internal Medicine, patients are at a “higher risk for developing heart disease than kidney failure (end stage renal disease)”. 

Newer drugs including ACE inhibitors and calcium-channel blockers are not any better than the older diuretic drugs, according to the new research.  These diuretic drugs (water pills) may even be more effective at preventing heart failure in patients with chronic kidney disease. 

Lead author of the study, Mahboob Rahman M.D. M.S., of Case Western Reserve University School of Medicine, University Hospitals of Cleveland and the Louis Stokes Cleveland VA Medical Center said "Overall, ACE inhibitors and diuretics were about equally likely to protect against heart attacks, but diuretics seemed more effective at preventing other kinds of cardiovascular diseases, such as stroke and heart failure."


The study included 31,000 men and women 55 years and older who had high blood pressure and one other risk factor for cardiovascular disease, such as diabetes.  A blood test was used to determine severity of kidney disease.

Of the patients with moderate chronic kidney disease, 38 percent had a great chance of developing heart disease and a 35 percent increased risk of overall cardiovascular disease (which includes heart disease, stroke, heart failure and others) than those with normal kidney function.  The “patients with moderate to severe chronic kidney disease were twice as likely to develop heart disease than to experience kidney failure”, according to the study.

The researchers are not sure why moderate and severe kidney disease leads to greater risk of heart disease.  Rahman said "It may be related to other factors associated with renal failure, such as anemia or abnormalities of calcium or phosphorus metabolism, for example. We are participating in other ongoing studies to establish the connections."


Of course there are things you can do to help prevent problems associated with heart and kidney disease. Rahman recommends "Exercise, maintaining optimal body weight, smoking avoidance, and maintaining low cholesterol levels – these are all things that should be done with renewed emphasis in most patients with high blood pressure. Most patient with hypertension and chronic kidney disease will require multiple medications to control blood pressure. Our results demonstrate that the risk for cardiovascular disease is lower if one of the medications is a diuretic."   

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