Published 21 August 2008, doi:10.1136/bmj.a679
Cite this as: BMJ 2008;337:a679

Practice

Uncertainties Page

Should we prescribe diuretics for patients with prediabetes and hypertension?

Bruce Arroll, professor , Timothy Kenealy, associate professor , C Raina Elley, senior lecturer

1 Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand 1142

Correspondence to: B Arroll b.arroll@auckland.ac.nz

The first 150 words of the full text of this article appear below.

The uncertainty arises from the findings of the large randomised controlled ALLHAT 2002 trial (31 512 people 55 years or older with hypertension and one other risk factor for cardiovascular disease), in which the thiazide-like diuretic chlortalidone seemed to increase some cardiac risk factors, including the rate of developing diabetes. After four years of follow-up in those who had a normal fasting blood glucose at baseline, 302 (11.6%) people taking chlortalidone, 154 (9.8%) of those taking amlodipine (a calcium channel blocker), and 119 (8.1%) of those taking lisinopril (an angiotensin converting enzyme inhibitor) had fasting blood glucose concentrations of ≥7 mmol/l (P<0.001).1 Diuretics are known to achieve long term cardiovascular results as good as, or better than, alternative antihypertensives—at least in people aged 55 years or older. But clinicians may not initially treat patients with prediabetes and hypertension with a diuretic because they worry that the induced diabetes might result . . . [Full text of this article]


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