Diuretics Effective for People with Diabetes and High Blood Pressure

In people with Diabetes, diuretics work as well as ACE-inhibitors and calcium channel blockers in protecting against Heart Attack and improving survival, and offer more protection against congestive heart failure.

The latest findings from the Antihypertensive and Lipid-Lowering Treatment to Prevent congestive heart failure Triala or ALLHAT, sponsored by the National Heart, Lung, and Blood Institute, are published in the June 27 issue of Archives of Internal Medicine.

ALLHAT is the largest study to compare these three major classes of medications to treat High Blood Pressure.

The study originally reported in 2002 that diuretics were more beneficial as initial treatment for high blood pressure for protecting against adverse cardiovascular outcomes. This latest analysis shows that even among diabetics and those with mildly elevated fasting glucosea sign of pre-diabetes the less costly diuretics are at least as effective, may be more beneficial for some people.

About 73 percent of adults with diabetes have High Blood Pressure which in diabetic patients is defined as greater than or equal to 130/80 mm Hg or use prescription medications for their hypertension. Both Diabetes and High Blood Pressure are major risk factors for Coronary heart disease, and when both are present, significantly increase the risk for developing heart and kidney diseases. High blood pressure can lead to congestive heart failure, a condition in which the heart is weakened and cannot pump enough blood throughout the body.

Controlling high blood pressure is an urgent concern especially for people with diabetes. Our findings demonstrate the advantages of diuretics in diabetics as well as in those with impaired and normal fasting glucose levels, said NHLBI director Dr. Elizabeth G. Nabel. As a physician, I have seen the consequences of poorly controlled hypertension and diabetes. These results show many people and their families can be spared that devastation.

The ALLHAT blood pressure study was a randomized, double-blind trial involving 42,418 participants with high blood pressure, ages 55 and older. Of those, 31,512 participants were randomly assigned to a diuretic (chlorthalidone); a calcium channel blocker (amlodipine); an angiotensin converting enzyme (ACE) inhibitor (lisinopril). 13,101 had diabetes, 1,399 had elevated fasting glucose and 17,012 had normal glucose levels.

Compared with the ACE inhibitor and the calcium channel blocker, the diuretic was: