Diuretics best first-step for high BP in diabetics

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Diuretics are just as effective for lowering High Blood Pressure (BP) in people with Type 2 diabetes as newer, and more expensive, types of drug, researchers said on Wednesday.

While angiotensin-converting enzyme (ACE) inhibitors have been recommended for patients with Diabetes who have High Blood Pressure and kidney damage, the best first-line treatment for hypertension in diabetic patients with no kidney damage is less certain, Dr. Paul K. Whelton of Tulane University Sciences Center and colleagues write in the Archives of Internal Medicine.

To investigate, the researchers analyzed results from 31,152 patients participating in the ALLHAT trial who had been randomly assigned to treatment with a thiazide type diuretic (chlorthalidone), a calcium channel blocker (amlodipine besylate), or an ACE inhibitor (lisinopril). 

Among the participants there were 13,101 patients with Type 2 diabetes, 1,399 with impaired fasting glucose, and 17,012 with normal levels of glucose.

After an average follow-up of nearly 5 years, there was no difference among the three drug treatment groups in rates of fatal Heart disease or nonfatal Heart attack, the researchers found.

Some significant differences in other outcomes were seen; for example, fatal or nonfatal Heart disease occurred 73 percent more often among subjects with impaired fasting glucose who were on the ACE inhibitor than those taking the diuretic.

Heart failure was more common among individuals with diabetes and those with normal blood glucose levels who taking the ACE inhibitor or the calcium channel blocker compared to those on the diuretic.

“The ALLHAT findings suggest that thiazide type diuretics should be strongly considered as first-step agents for therapy in patients with hypertension and Type 2 diabetes or impaired fasting glucose,” the researchers conclude.

“These agents are not only efficacious but have been evaluated in many trials and are the least expensive medications to prescribe,” they add.

SOURCE: Archives of Internal Medicine, June 27, 2005.

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