Diuretics Best Option For Diabetics With High Blood Pressure

Large study finds they work as well as more expensive drugs

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HealthDay Reporter

MONDAY, June 27, 2005 (HealthDayNews) -- For people with type 2 diabetes and high blood pressure, cheaper diuretic medications may be the most cost-effective option in reducing hypertension, a major new study finds.

"Diuretics are the optimal choice for initial therapy," said lead author Dr. Paul K. Whelton, senior vice president for health sciences at Tulane University.

Newer, more expensive drugs "did not perform better in reducing heart attacks or death from heart disease," Whelton added. "Diuretics are the appropriate first choice, not only for people who don't have any indication of diabetes, but for people with diabetes or prediabetes."

The finding is based on data collected as part of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the largest clinical trial on high blood pressure ever conducted. The report appears in the June 27 issue of the Archives of Internal Medicine.

In their study, Whelton and his team collected data on more than 31,500 adults aged 55 and older. All of the participants had high blood pressure and at least one other condition putting them at risk for heart disease. The study included over 13,100 people with type 2 diabetes, nearly 1,400 people with high blood sugar (pre-diabetes) and more than 17,000 people with normal blood sugar levels.

The researchers compared the benefits of three drug types in controlling blood pressure in these individuals: a diuretic; another type of drug called a calcium channel blocker; and a third type, an angiotensin-converting enzyme inhibitor (ACE inhibitor).

They found no significant difference between the drugs in controlling blood pressure in any group when used as initial treatment. Based on these findings, Whelton believes that for most people with high blood pressure, the cheaper diuretics are the appropriate therapy for high blood pressure.

However, he cautioned that patients already taking an effective blood pressure medication shouldn't make any sudden change to their therapy.

"If you are thinking about a treatment or a change in treatment, you should talk with your doctor," Whelton said. "Don't willy-nilly change something. Before you react to any publication, you should talk to your doctor."

However, one expert cautioned that, despite the cost advantage of using diuretics, they might not be best for all patients, and new drugs not tested in ALLHAT might still be more effective for some diabetics.

"This study doesn't really show anything that differentiates these drugs," said Dr. Stuart Weiss, an endocrinologist and clinical assistant professor of medicine at New York University School of Medicine. "But then again, these are the first-line drugs that a lot of physicians use."

In addition, he noted, "Most patients who are diabetic require multiple medications to control their blood pressure."

Weiss believes different medications work better for different patient types. For people who consume too much salt, diuretics are a good initial treatment for high blood pressure. They also seem to work especially well for black patients. "For others, there are different first-line choices," he said. "You can't use these large studies to clinically dictate the approach that individual physicians should take in treating their patients."

Other drugs, such as angiotensin II receptor blockers (ARB), may be more effective than any of the drugs tested in ALLHAT, Weiss said. "There are studies that show that by using Diovan, an ARB, in controlling blood pressure, there was a decrease in new-onset diabetes," he said.

Weiss said he prefers certain ACE inhibitors or an ARB as initial treatment. "Those drugs have been shown in large population-based studies to delay the onset of diabetes and also to decrease insulin resistance as they lower blood pressure," he said.

If these drugs fail to lower blood pressure to a target level, then Weiss usually prescribes a diuretic. "The best way to get the blood pressure down after that is to add a low dose of a diuretic," he said.

More information

The American Heart Association can tell you more about high blood pressure.

SOURCES: Paul K. Whelton, M.D., senior vice president, health sciences, Tulane University, New Orleans; Stuart Weiss, M.D., clinical assistant professor, medicine, New York University School of Medicine, New York City; June 27, 2005, Archives of Internal Medicine

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