A determination of effectiveness of three new blood pressure-lowering drugs; lisinopril, amlodipine, and doxazocin as compared to the standard forms of treatment with diuretic drugs. An estimated 50 million people in the United States have elevated blood pressure or are taking medications for high blood pressure. There is known relationship between high blood pressure and coronary heart disease (CHD), but large-scale, randomized clinical trials in mild to moderately high blood pressure in largely middle-aged subjects failed to show that high blood pressure drug treatment reduces the occurrence of cardiac disease death or non-fatal myocardial infarction (the death of heart tissue due to lack of blood supply to the area). The primary hypothesis of this trial is that the combined incidence of fatal heart disease and non-fatal myocardial infarction will be lower in patients with high blood pressure who receive the three medications. The study will involve a population of men and women 55 years and older, all with at least one additional CHD risk factor besides high blood pressure, 55% of whom will be African-American, a race more prone to high blood pressure. There will be a trial component to lower blood pressure and a trial component to lower cholesterol. Study drugs will be randomly assigned. Patients will be seen at four week intervals until a reasonably stable regimen with satisfactory blood pressure control has been achieved. Clinic visits will then take place every three months during the first year and every four months thereafter. Blood pressure will be taken at each visit. An electrocardiogram test will be given at visit two. Potassium levels will be checked at one month, one year, two years, four years, and at six years. Blood tests will be done as well as tests for creatinine serum., fasting cholesterol, and serum glucose. At every visit, a determination of compliance with study medications will be done. Quality of life will be discussed at the entry of the study and every year thereafter.
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