Issue 158 Item 7 Water Pills Increase Diabetes Risk in Major Study

Diuretics More Likely To Cause Diabetes Then ACE Inhibitors Or Calcium Channel Blockers. Patients randomized to diuretics in the landmark ALLHAT were more likely to develop new onset diabetes than patients randomized to either a calcium channel blocker or an angiotensin-converting enzyme (ACE) inhibitor to control high blood pressure, according to results But Dr. Joshua Barzilay, clinical associate professor of medicine at Emory University, Atlanta, Georgia, said that the increase in new onset diabetes did not translate into an increased risk of cardiovascular events.

“After four years of follow-up,” Dr. Barzilay said, “these differences in new onset diabetes did not translate into more coronary heart disease events, or into higher all-cause mortality, in the chlorthalidone group. Indeed, risk of certain cardiovascular disease outcomes was lower with chlorthalidone treatment.”

In the 42,000-patient ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) researchers compared four types of anti-hypertensive drugs. The treatment arm containing the alpha-adrenoceptor blocker doxazosin was been found to be less effective than the diuretic chlorthalidone in reducing hypertensive heart failure, and that arm of the trial was discontinued early. Meanwhile the study went on to compare chlorthalidone with lisinopril and amlodipine.

Dr. Barzilay said that at baseline the fasting glucose level for the patients on the diuretic was 116 mg/dL. For amlodipine, it was 115.5 mg/dL, and for lisinopril it was 116.1 mg/dL. After two years the fasting glucose level for chlorthalidone was 129.7 mg/dL, 122.6 mg/dL for amlodipine, and 115.8 mg/dL for lisinopril. After four years, the fasting glucose was 129.2 mg/dL for chlorthalidone, 130.5 mg/dL for amlodipine and 116.7 mg/dL for lisinopril. After two years 9.3% of the patients assigned to chlorthalidone had a fasting glucose of 126 mg/dl, which was the study definition for diabetes mellitus, compared to 6.4% of those on amlodipine and 5.9% of those on lisinopril, Dr. Barzilay said. The incidence of diabetes mellitus was 11.6% of those on chlorthalidone after four years, while 9.8% of those on amlodipine and 8.1% of those on lisinopril had developed diabetes.

“Lisinopril did play some form of protective effect against diabetes,” Dr. Barzilay said, but he noted that at the end of the trial there were no major differences between the drugs in endpoints.

He suggested that further studies might be able to determine if costs are increased because those patients who develop diabetes need further treatments.

Presented at the 19th Annual Scientific Meeting of the American Society of Hypertension.

Learn about the First Step Program, a program to increase physical activity, that has gone through 8 years of clinical studies to show it’s effectiveness. www.firststepprogram.com

===========================

Dr. Richard Bernstein’s book the Diabetes Solution NEW AND REVISED Special Pricing for Subscribers of Diabetes In Control 512 pages packed with new information on Diet, Exercise, Curbing Carbohydrate cravings, new insulin regimens, monitoring blood sugars, helping physicans and patients to regulate blood sugars plus much, much more. “RUN DON’T WALK TO GET THIS BOOK” — Michael R. Eades, M.D. Author of Protein Power. “Please read this book, if you really want to be proactive in the lifelong battle against diabetes and its complication.” — John A. Colwell, M.D., Ph.D., former President, ADA. This book should be in the library of every diabetic patient, and especially Physician’s who treat diabetes.” — Barry Sears, Ph.D., author of THE ZONE. “ More Information: www.diabetes-solution.net