(Reuters Health) Chlorthalidone-based treatment improves long-term outcomes associated with isolated systolic hypertension, especially among patients with diabetes, according to a report in the January 1st issue of the American Journal of Cardiology.
Despite their beneficial effects on hypertensive complications, diuretics have been associated with the development of diabetes, the authors explain. Whether diuretic therapy adversely affects morbidity and mortality among diabetics is controversial.
Dr. John B. Kostis from UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey and colleagues in the Systolic Hypertension in the Elderly Program (SHEP) Collaborative Research Group examined the 14.3-year mortality rate associated with chlorthalidone or placebo treatment and the presence or development of diabetes.
Overall, the cardiovascular mortality rate was lower in the chlorthalidone group (19.0%) than in the placebo group (21.7%), the authors report, though mortality rates were higher among those who had diabetes at baseline and among those who developed diabetes while on diuretic therapy.
Diabetic patients randomized to chlorthalidone treatment had overall mortality rates 20% lower than those in diabetic patients randomized to placebo, the report indicates. The beneficial effect of chlorthalidone treatment was more pronounced when cardiovascular mortality was considered.
Diabetes diagnosed during diuretic therapy was generally mild and not associated with a significant increase in overall or cardiovascular mortality, the results indicate.
Mortality rates did not differ significantly between the groups when only nondiabetic patients were considered, the researchers note. Moreover, mortality rates did not differ between chlorthalidone-plus-atenolol and chlorthalidone-alone groups regardless of diabetic status.
“These findings support the recommendations of the seventh report by the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, in which diuretics (in addition to beta-blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers) should be considered first-line therapy for hypertension, including in patients who have diabetes,” the authors conclude.
“Early control of blood pressure is very important,” Dr. Kostis told Reuters Health, “and diuretics have long-term beneficial effects.”
Am J Cardiol 2005;95:29-35.
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