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NHS advice refutes risk from thiazides

The National Prescribing Centre (NPC) has dismissed evidence revealed by Pulse that thiazides are the dominant cause of the increase in new onset diabetes associated with a combination of ß-blockers and diuretics.

In its blog, which aims to advise healthcare professionals about topical issues that may affect their practice, the NPC explicitly advises using a thiazide diuretic as the first-choice treatment for lowering blood pressure in people with type 2 diabetes.

This advice conflicts with a study presented last week by Professor Morris Brown, the president of the British Hypertension Society, which suggested that thiazide monotherapy poses a bigger risk of developing diabetes than ß-blocker treatment.

NICE hypertension guidance published last year demoted ß-blockers – but not thiazides – to third-line therapy.

It followed the ASCOT study, which found that a ß-blocker-thiazide combination was associated with a 30% increased risk of new onset diabetes.

Dr Neil Maskrey, director of evidence-based therapeutics at the NPC, who defended the blog advice, said: ‘What we're interested in is whether people live longer and better, not whether they develop diabetes. What we're representing is the current evidence base.'

NICE was unable to comment on Professor Brown's study as it had not yet had time to consider the research.

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