Diuretika?Erste Wahl bei der Hypertoniebehandlung?

Abstract

The role of diuretics in the treatment of arterial hypertension remains a matter of controversy. On the basis of the results of recent studies and economic considerations a broader use of diuretics in the initial antihypertensive therapy has been proposed. The present review analyses two aspects of diuretics which are of interest in this debate. Thus, several studies demonstrate that diuretic therapy is associated with a greater incidence of new-onset diabetes as compared to calcium channel blockers, ACE-inhibitors and AT(1)-antagonists. The clinical relevance of this effect becomes clear when calculating the "numbers needed to treat" (NNT) on the basis of a long-term therapy over several decades. Based on the assumption of linear increases in the incidence of diabetes over time NNT then become remarkably small and in some studies number < 10. Another problem associated with diuretics is the low compliance and persistence with this type of drugs established in "real life" studies in which patients were not disciplined by the study design. These characteristics of diuretic therapy of hypertensive patients challenge the proposed medical and also economic benefit of diuretics as compared to more "modern" antihypertensive agents.