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Diabetics with High Blood Pressure Benefit
from Older, Cheaper Pills
In people with diabetes, traditional diuretics work as well as newer medications – ACE-inhibitors and calcium channel blockers – in protecting against heart attack and improving survival, and may offer more protection against heart failure, according to results from the largest hypertension clinical trial ever conducted.
The latest findings from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, or ALLHAT, sponsored by the National Heart, Lung and Blood Institute, were published in the June 27 issue of Archives of Internal Medicine.
Barry R. Davis, M.D., Ph.D., professor of biostatistics in The University of Texas School of Public Health, is the principal investigator and a co-author of the Archives of Internal Medicine article. ALLHAT Project Manager Sara Pressel, a faculty associate at the School of Public Health, also is a co-author.
ALLHAT randomly assigned 31,512 participants age 55 or older to a diuretic, a calcium channel blocker or an angiotensin converting enzyme (ACE) inhibitor. Of these participants: 13,101 had diabetes; 1,399 had elevated fasting glucose, a sign of pre-diabetes; and 17,012 had normal glucose levels.
Study results showed that people with type 2 diabetes and high blood pressure have a reduced risk of heart failure and stroke if they take diuretics to control their blood pressure.
“We might be able to save 40,000 to 50,000 serious illnesses per year, including heart failures and strokes, if people with high blood pressure incorporate a diuretic into their regimen.” Davis said.
About 73 percent of adults with diabetes have high blood pressure – for diabetics, defined as greater than or equal to 130/80 mm Hg – or use prescription medications for hypertension. Both diabetes and high blood pressure are major risk factors for coronary heart disease, and the combination puts people at particularly high risk for developing heart disease and renal disease.
Tulane University physician and epidemiologist Paul K. Whelton, M.D., senior vice president for health sciences, is lead author for the current report. Initial findings were published in The Journal of the American Medical Association in December 2002. The study was conducted at 623 clinics and centers across the United States and in Canada, Puerto Rico and the U.S. Virgin Islands.
By David R. Bates, Public Affairs