Effects of low dose versus conventional dose thiazide diuretic on insulin action in essential hypertension

Harper, Ray; Ennis, C. N.; Sheridan, B.; Atkinson, A. B.; Johnston, G D; Bell, P. M.

doi:10.1136/bmj.309.6949.226

Cited by 83 publications

(56 citation statements)

References 34 publications

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“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][36][37][38][39][40][41][42] The only biochemical variable that is affected by most antihypertensive diuretics irrespective of the dose is serum uric acid concentration, which undergoes a small increase, on average, even when low doses are used. 13,21,43 Cicletanine 50 mg does not modify the renal handling of urate, 44 and it does not elevate serum uric acid concentration.…”

Section: Safety Of Diuretics At Low Dosesmentioning

confidence: 99%

Diuretics in the therapy of hypertension

Reyes¹

2002

J Hum Hypertens

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Antihypertensive monopharmacotherapy with diuretics renders blood pressure (BP) values under control in a large percentage of patients suffering from essential hypertension, and it reduces cardiovascular morbidity and mortality. Diuretics are effective in adult and elderly hypertensive subjects, independently of their race. Treatments with classic (high) doses of antihypertensive diuretics, such as 25 mg hydrochlorothiazide once daily, raise the activity of the RAA system, decrease plasma potassium and magnesium concentrations, and cause untoward changes in carbohydrate metabolism and in the plasma lipid profile. These changes appear to limit the positive response of cardiovascular prognosis to antihypertensive therapy with classic doses of diuretics. Lower doses of diuretics reduce high BP to the sought extent in many patients, and they do not

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Section: Safety Of Diuretics At Low Dosesmentioning

confidence: 99%

Diuretics in the therapy of hypertension

Reyes¹

2002

J Hum Hypertens

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“…Thiazide diuretics worsen glycemic control in a dose-dependent fashion by decreasing insulin secretion and peripheral insulin sensitivity [77,[87][88][89]97]. Hypokalemia (and perhaps hypomagnesemia) may play an important role in thiazide-induced glucose intolerance [77,[97][98][99], and deterioration in glucose metabolism occurs even with minimal decreases in serum potassium levels [90].…”

Section: Mechanismsmentioning

confidence: 99%

“…Even though there is an abundance of evidence supporting the beneficial effects of thiazide diuretics on cardiovascular outcomes, these agents may accelerate the onset of T2DM in patients with hypertension (particularly when used in high doses) [77,[87][88][89][90][91][92][93], although older studies often had method limitations [93]. In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attacks Trial (ALLHAT) [70], the odds ratio of developing of developing T2DM at 2 years was significantly lower for lisinopril and amlodipine (0.55, P < .…”

Section: Thiazide Diuretics Clinical Datamentioning

confidence: 99%

“…Outcome data related to newonset T2DM, possible mechanisms by which different classes of agents promote or prevent T2DM, and treatment recommendations are summarized in Table 4, Table 5, and Table 6. Table 4 presents the results of major outcome trials [7,[63][64][65][66][67][68][69][70][71][72][73][74][75][76]; Table 5 summarizes actions of the different classes of antihypertensive agents that may contribute to their effects on T2DM; Table 6 lists treatment recommendations supported by individual study results [7,[77][78][79][80][81][82][83][84][85]. A network meta-analysis (which accounts for both direct and indirect comparisons between classes of drugs) of 22 randomized clinical trials, involving 143,153 participants, was conducted to estimate the relative odds of developing T2DM with an initial class of antihypertensive drug [86].…”

Section: T2dm Risk and Selection Of Antihypertensive Therapymentioning

confidence: 99%

“…Hypokalemia (and perhaps hypomagnesemia) may play an important role in thiazide-induced glucose intolerance [77,[97][98][99], and deterioration in glucose metabolism occurs even with minimal decreases in serum potassium levels [90]. Patients receiving thiazide diuretics (and β-blockers) have significantly higher plasma fibrinogen levels and lower HDL levels than those receiving CCBs, ACE inhibitors, or ARBs [70,100].…”

Section: Mechanismsmentioning

confidence: 99%

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Treating hypertension while protecting the vulnerable islet in the cardiometabolic syndrome

Hayden

Sowers

2008

Journal of the American Society of Hypertension

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Hypertension, a multifactorial-polygenic disease, interacts with multiple environmental stressors and results in functional and structural changes in numerous end organs, including the cardiovascular system. This can result in coronary heart disease, stroke, peripheral vascular disease, congestive heart failure, end-stage renal disease, insulin resistance, and damage to the pancreatic islet. Hypertension is the most important modifiable risk factor for major health problems encountered in clinical practice. Whereas hypertension was once thought to be a medical condition based on discrete blood pressure readings, a new concept has emerged defining hypertension as part of a complex and progressive metabolic and cardiovascular disease, an important part of a cardiometabolic syndrome. The central role of insulin resistance, oxidative stress, endothelial dysfunction, metabolic signaling defects within tissues, and the role of enhanced tissue renin-angiotensin-aldosterone system activity as it relates to hypertension and type 2 diabetes mellitus is emphasized. Additionally, this review focuses on the effect of hypertension on functional and structural changes associated with the vulnerable pancreatic islet. Various classes of antihypertensive drugs are reviewed, especially their roles in delaying or preventing damage to the vulnerable pancreatic islet, and thus delaying the development of type 2 diabetes mellitus.

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Detection of type 2 diabetes mellitus in general practice: do the patients' dossiers provide clues?

Rutten

Boomsma

2000

Pract Diab Int

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In a general practice the history of all known 67 type 2 diabetes patients was compared with that of randomly chosen sex/age matched control persons who did not develop diabetes. All medical dossiers were scrutinized up to at least ten years before the diagnosis diabetes was made to establish determinants in patients' dossiers that correlate with a later diagnosis of diabetes mellitus. The history of the type 2 diabetes patients (43 female, 24 male) revealed signi®cantly more ®rst degree related members with known type 2 diabetes (64% versus 13%), body mass index >27 (63% versus 28%), hypertension (69% versus 37%), prescribed diuretics (54% versus 22%), hypertension with prescribed diuretics (46% versus 18%) and hypertension with BMI >27 (51% versus 19%). The same applied to the female type 2 diabetes patients taken separately. In the women with later type 2 diabetes 44% (controls 5%) of the pregnancies were complicated by toxicosis or a high birth weight. In the dossiers of the male diabetic patients only obesity was signi®cantly more recorded compared with the dossiers of the controls. On the basis of the above mentioned ®ndings the general practitioner/family physician should perform case ®nding for type 2 diabetes. In this way especially women may be recognized as diabetic patients at an early stage.

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Effects of low dose versus conventional dose thiazide diuretic on insulin action in essential hypertension

Cited by 83 publications

References 34 publications

Diuretics in the therapy of hypertension

Diuretics in the therapy of hypertension

Treating hypertension while protecting the vulnerable islet in the cardiometabolic syndrome

Detection of type 2 diabetes mellitus in general practice: do the patients' dossiers provide clues?

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