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[Diuretics-first line treatment for hypertension?]
1Medizinische Universitäts-Poliklinik, Bonn, Germany. duesing@uni-bonn.de
Herz
|December 23, 2003
Summary
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.