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[Diuretics-first line treatment for hypertension?]

Rainer Düsing1

  • 1Medizinische Universitäts-Poliklinik, Bonn, Germany. duesing@uni-bonn.de

Herz
|December 23, 2003
PubMed

Insights

Diuretic therapy for hypertension increases new-onset diabetes risk, especially with long-term use. Poor patient compliance further challenges their proposed benefits over newer medications.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Diuretics are commonly used for arterial hypertension treatment.
  • Recent studies and economic factors suggest broader initial use of diuretics.
  • Controversy exists regarding the long-term efficacy and safety of diuretics.

Purpose of the Study:

  • To analyze the incidence of new-onset diabetes with diuretic therapy.
  • To evaluate patient compliance and persistence with diuretic medications.
  • To challenge the proposed medical and economic benefits of diuretics compared to other antihypertensives.

Main Methods:

  • Review of recent studies on diuretic therapy in hypertension.
  • Analysis of comparative incidence of new-onset diabetes.
  • Assessment of patient compliance and persistence in real-life studies.

Main Results:

  • Diuretic therapy is linked to a higher incidence of new-onset diabetes compared to calcium channel blockers, ACE-inhibitors, and AT(1)-antagonists.
  • The "numbers needed to treat" (NNT) for diabetes development can be remarkably small (<10) with long-term diuretic use.
  • Real-world studies show low patient compliance and persistence with diuretics.

Conclusions:

  • The increased risk of new-onset diabetes and poor compliance question the benefits of diuretics.
  • Diuretics may not offer the same medical or economic advantages as newer antihypertensive agents.
  • Further evaluation is needed to balance the risks and benefits of diuretics in hypertension management.
Abstract

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