New research by The University of Texas School of Public Health shows that a medication for high blood pressure called a diuretic or water pill is particularly effective at reducing the risk for a type of heart failure that affects women more often than men.
Findings appear in the Nov. 10 online issue of Circulation: Journal of the American Heart Association.
Heart failure is a clinical syndrome characterized by an inadequate supply of oxygen rich blood as a result of impaired cardiac pump function. More than 5 million Americans are living with heart failure and most had high blood pressure before developing this potentially deadly condition.
While much research has been focused on the impact of antihypertensive medications on the prevention of heart failure associated with reduced pumping capacity in the heart's all-important left ventricle, comparatively little research has been performed on the prevention of heart failure wherein the heart muscle is clearing a normal or preserved percentage of blood with each heart beat. This percentage is called left ventricular ejection fraction (LVEF).
"We showed that a diuretic was as good as or better than other classes of medication for high blood pressure in reducing the occurrence of heart failure in people with a wide range of left ventricular ejection fraction," said Barry Davis, M.D., Ph.D., the study's lead author, the Guy S. Parcel Chair in Public Health and director of the Coordinating Center for Clinical Trials at the UT School of Public Health.
The study involved 910 hypertensive adults who had been taking antihypertensive medications and who were subsequently diagnosed with heart failure in a hospital. Those with an ejection fraction of 50 percent or more were defined as Heart Failure Preserved Ejection Fraction (HFPEF) and those with an ejection fraction of 49 percent or less as Heart Failure Reduced Ejection Fraction (HFREF). Forty-four percent had preserved ejection fraction and 56 percent reduced ejection fraction.
Participants treated with a thiazide-type diuretic (chlorthalidone) had reduced risk of Heart Failure Preserved Ejection Fraction compared to those taking a calcium channel blocker (amlodipine), an angiotensin-converting enzyme inhibitor (lisinopril), or an alpha-adrenergic blocker (doxazosin). Chlorthalidone reduced the risk in people with reduced ejection fraction compared with amlodipine or doxazosin. Chlorthalidone was similar to lisinopril in preventing heart failure with reduced ejection fraction. "On the basis of the data from many heart failure trials, a combination of the last two agents would be expected to be particularly effective in preventing heart failure in this group," the authors wrote.
"In both heart failure with preserved and reduced ejection fraction, the diuretic is helping to remove excess fluid - which can reduce both pre load and after load and thus increase ejection fraction," Davis said.