Diuretics Look Promising

Published Online: Thursday, September 1, 2005

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) revealed interesting data on diabetes, according to a study reported in the Archives of Internal Medicine (June 27, 2005). The study showed that diuretics are just as effective as angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (CCBs) in preventing heart attack and improving survival rates.

The randomized, double-blind study involved 42,418 participants with hypertension, aged 55 and older. Of the participants, 31,512 were assigned to a diuretic (chlorthalidone), an ACE inhibitor (lisinopril), and a CCB (amlodipine). Of these participants, 13,101 had diabetes, 1399 had elevated fasting glucose, and 17,012 had normal glucose levels.

A comparison of the diuretic with the ACE inhibitor and the CCB found that the diuretic was:

  • More protective against congestive heart failure in patients both with and without diabetes
  • More effective in lowering systolic pressure among those with and without diabetes
  • At least equally protective against fatal coronary artery disease or nonfatal heart attacks in patients with diabetes, those with elevated fasting glucose, and those without diabetes

"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 Elizabeth G. Nabel, MD, director of the National Heart, Lung, and Blood Institute, which sponsored the study. "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."



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