Diuretics Look Promising

The Antihypertensive and Lipid-LoweringTreatment to Prevent Heart AttackTrial (ALLHAT) revealed interestingdata on diabetes, according to a studyreported in the Archives of InternalMedicine (June 27, 2005). The studyshowed that diuretics are just as effectiveas angiotensin-converting enzyme(ACE) inhibitors and calcium channelblockers (CCBs) in preventing heartattack and improving survival rates.

The randomized, double-blind studyinvolved 42,418 participants with hypertension,aged 55 and older. Of theparticipants, 31,512 were assigned toa diuretic (chlorthalidone), an ACEinhibitor (lisinopril), and a CCB(amlodipine). Of these participants,13,101 had diabetes, 1399 had elevatedfasting glucose, and 17,012 hadnormal glucose levels.

A comparison of the diuretic withthe ACE inhibitor and the CCB foundthat the diuretic was:

• More protective against congestiveheart failure in patients bothwith and without diabetes
• More effective in lowering systolicpressure among those with andwithout diabetes
• At least equally protective againstfatal coronary artery disease ornonfatal heart attacks in patientswith diabetes, those with elevatedfasting glucose, and those withoutdiabetes

"Controlling high blood pressure isan urgent concern, especially for peoplewith diabetes. Our findings demonstratethe advantages of diuretics in diabeticsas well as in those with impairedand normal fasting glucose levels," saidElizabeth G. Nabel, MD, director of theNational Heart, Lung, and Blood Institute,which sponsored the study. "As aphysician, I have seen the consequencesof poorly controlled hypertensionand diabetes. These results showmany people and their families can bespared that devastation."