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Diuretics 'as effective as calcium channel blockers'

By Lilian Anekwe

Diuretics are at least as effective as calcium channel blockers for treating hypertension even in patients at particularly high risk of diabetes, a new study concludes.

An analysis of the influential ALLHAT trial found diuretics matched calcium channel blockers at controlling cardiovascular events in patients with the metabolic syndrome.

Diuretics were associated with relatively high rates of new-onset diabetes, but that appeared to have no effect on the control of blood pressure or on the incidence of cardiovascular disease.

In patients with metabolic syndrome, there were no statistically significant differences in either cardiovascular or renal outcomes between those given calcium channel blockers and those given diuretics.

But patients on an ACE inhibitor were 31% more likely to progress to heart failure and 19% more likely to develop cardiovascular disease than those given a diuretics.

After four years of follow-up, 17% of patients on diuretics developed type 2 diabetes, compared with 16% with calcium blockers and 13% with ACE inhibitors.

The research was published online in Diabetes Care.

Study leader Dr Henry Black, professor of internal medicine at the New York University school of medicine, concluded: ‘Despite a less fa-vourable metabolic profile, thiazide diuretic initial therapy offers similar, and in some instances possibly superior, cardiovascular disease out-comes in older hypertensive adults with metabolic syndrome.'

Dr Mike Mead, a GP in Leicester and chair of the Blood Pressure Association's healthcare advisory panel, said the results were surprising.

‘There a huge amount to dissect and say about the ALLHAT trial.

‘A higher incidence of diabetes is obviously not what one would want. I don't know how anyone can say that a drug that makes you more likely to develop diabetes should be our first choice antihypertensive.

‘In practice, you want patients with metabolic syndrome on statins and you want their blood pressure down, most sensibly by a combination of ACE inhibitors and thiazides.

‘Modern hypertension management is based more and more on combination therapy, and less and less on which drug is better than which other. For GPs, the most appropriate combination is AC or AD, progressing to ACD.'

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