Study Unlikely to Change Use of Hypertension Drugs

Experts say diuretics safe enough, but alternatives do exist

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HealthDay Reporter

TUESDAY, Jan. 4, 2005 (HealthDayNews) -- Doctors welcomed a new study finding that commonly used hypertension drugs have a long-term heart benefit even though they increase the risk of diabetes, but added that the results probably won't change their prescribing practices.

The study found that treating elderly people who have high blood pressure with the drugs, called diuretics, lowered their rate of death from heart attacks and strokes over the long haul -- even among those who developed diabetes while taking the pills.

Although the results affirm the overall safety record of diuretics, several experts said they are still likelier to turn to other blood pressure drugs, especially among patients who are at risk for acquiring the blood sugar disorder.

"I'm not sure that this changes anything dramatically, but I think it's another supportive piece of evidence," said Dr. Michael Fischer, an associate physician at Brigham and Women's Hospital and instructor in medicine at Harvard Medical School.

"The trial is informative, but it's not going to change much in the way of practice other than to confirm what we probably suspected, which is it's the blood pressure that kills you, not the blood sugar," added Dr. Richard Milani, section head of preventive cardiology at the Ochsner Clinic Foundation in New Orleans. "I still think the first-line therapy for hypertension and metabolic disorder and diabetes should be an ACE inhibitor or an angiotensin receptor blocker. If an additional agent was needed I would have no hesitation in adding a diuretic, and I think most people have been practicing that way."

Doctors have known for years that the chance of getting diabetes is about 2 to 3 percent higher in people who take diuretics.

"Some physicians don't use diuretics in all or some patients because of this fear of diabetes," said Dr. John Kostis, lead author of the study appearing in the January issue of the American Journal of Cardiology and chair of the department of medicine at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School.

Other experts felt that the question of whether to give diuretics was never really answered because most of the relevant studies lasted only about four to five years -- not long enough to see if the diabetes really caused significant harm.

The new study followed 4,732 participants for more than 14 years and is therefore meant to allay those concerns. They took either the diuretic chlorthalidone or a placebo. Even though diuretics increased the risk of diabetes, the overall mortality rate was lower in people taking the diuretic.

"This is reassuring, and it shows that those who had diabetes to begin with or those who developed diabetes did better if they took diuretics than if they did not take diuretics," Kostis said.

"This article shows that the increase in blood sugar you see with these medications, at least based on what they're finding here, is just a mild increase and doesn't seem to have huge consequences in the long term for patients," Fischer said.

Although diuretics are already widely used, this information may boost their use even more.

"Diuretics have been reasonably widely used, although not to the extent that the evidence would suggest," Fischer said. "There's been a general feeling that the use has been increasing in the last few years, and that's as good thing."

One major advantage to diuretics is that they are cheap. "It's good in terms of affording medications," Fischer said.

On the other hand, Milani pointed out, many ACE inhibitors are now available in generic form, and are less expensive. These drugs do not increase blood sugar levels.

"There should not be an enormous fear of using diuretics in people with pre-diabetes or metabolic syndrome or diabetes, but, likewise, if there is another drug that would give them additional benefit and wouldn't cost more, that would be probably my first choice," Milani said. "If everything's equal and every drug has the same effect and costs the same and you walked into my office and you had metabolic syndrome or diabetes, I'm going to pick an ACE inhibitor or an angiotensin receptor blocker."

But having two types of drugs that are affordable is definitely a good thing.

"It's nice to have a few inexpensive alternatives to pick from," Fischer said.

More information

The American Heart Association has more on blood pressure medications.

SOURCES: Michael A. Fischer, M.D., associate physician, Brigham and Women's Hospital and instructor in medicine, Harvard Medical School, Boston; John B. Kostis, M.D., chair, department of medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, N.J.; Richard Milani, M.D., section head of preventive cardiology, Ochsner Clinic Foundation, New Orleans

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