Effect of Thiazides on Carbohydrate Metabolism in Patients with Hypertension

Shapiro, Alvin P.; Benedek, Thomas G.; Small, Jean

doi:10.1056/nejm196111232652102

Cited by 127 publications

(31 citation statements)

References 13 publications

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“…Symptoms of hypopotassemia have been avoided by an extensive use of potassium chloride orally (usually with serumpotassium of 3.5 m.Eq/L or less), which also is supposed to give a further depression of blood pressure, especially with a serumpotassium value near the lower border of its normal range (25). A hyperglycemic effect of thiazide agents with development of clinical diabetes mellitus has been found in patients with "latent diabetes" (11,33). This was observed in one of our patients as described above.…”

Section: Discussionsupporting

confidence: 76%

Guanethidine and Chlorthalidonein Hypertension

Stokke¹,

Hs²

1963

Cardiology

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Section: Discussionsupporting

confidence: 76%

Guanethidine and Chlorthalidonein Hypertension

Stokke¹,

Hs²

1963

Cardiology

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“…5 Diuretics may raise blood sugar, worsening the control of diabetes mellitus or precipitating its manifestations. 6 More recently, it has been shown that diuretic therapy of hypertension may raise serum lipid levels. 7 The latter 111-132 observation has been invoked to explain the failure of some therapeutic trials in hypertension to demonstrate a reduction in coronary artery disease rates.…”

mentioning

confidence: 99%

Influence of an angiotensin converting-enzyme inhibitor on diuretic-induced metabolic effects in hypertension.

Weinberger¹

1983

Hypertension

105

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SUMMARY Diuretic therapy is frequently accompanied by undesirable biochemical changes and side-effects. Two multicenter trials compared the effects of captopril combined with a diuretic to the administration of either agent alone in mild-to-moderate hypertensives. In addition to blood pressure, effects on serum potassium, uric acid, glucose, and cholesterol were examined. The first study (Study A) was conducted on 210 such patients randomly assigned to receive: 1) hydrochlorothiazide (H) 15 mg three times daily (t.i. In Study A, the combination of C + H (A-3) produced a significantly greater (p < 0.001) reduction in blood pressure than either agent alone. In Study B, both C + H groups (B-l, B-2) had a significantly greater (p < 0.01) blood pressure reduction than that seen with C alone (B-3).In Study A, those treated with H alone (A-l) had a significant (p < 0.05) reduction in serum potassium and increases in uric acid, glucose, and cholesterol when compared to C alone (A-2) where no changes in these parameters were observed. Further, the addition of C to H (A-3) blunted the magnitude of changes in potassium and uric acid and prevented the significant rise in glucose and cholesterol seen with H alone. Similar changes were seen in the Study B where H alone was associated with marked (p < 0.05) changes in potassium, uric acid, and glucose. With C alone, no such changes were observed, and with the combination (B-l, B-2) the magnitude of change was again blunted. Taken together, these studies demonstrate the impressive additive antihypertensive effect of combining an angiotensin converting-enzyme inhibitor with a thiazide diuretic. The observations confirm the multiple metabolic effects of thiazide therapy. Finally, these studies indicate that the addition of captopril to hydrochlorothiazide can blunt or even prevent the metabolic consequences of diuretic therapy while enhancing their antihypertensive effect. Thus, this combination has great promise for the treatment of mild-to-moderate hypertension. Diuretics were among the first antihypertensive agents, followed by a number of increasingly specialized and effective agents. Since the advent of antihypertensive therapy, several studies have been conducted demonstrating the beneficial effect of blood pressure reduction on cardiovascular morbidity and mortality. Recent studies have been interpreted by some investigators as suggesting that certain antihypertensive drugs, particularly those of the diuretic

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“…Several studies have shown diuretics to be associated with glucose intolerance [13][14][15][16][17][18][19]. However, a 2006 retrospective observational cohort of 100,653 previously untreated hypertensive elderly patients suggested that incident type 2 diabetes was not increased by thiazide diuretics [20].…”

Section: Diureticsmentioning

confidence: 99%

Lipid Effects of Antihypertensive Medications

Deaño

Sorrentino

2011

Curr Atheroscler Rep

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Thiazide diuretics and beta-blockers are first-line therapies for hypertension unless there are compelling indications for other drug classes. Diuretics and beta-blockers, however, may worsen dyslipidemia and glucose tolerance whereas antihypertensive agents in other drug classes may have neutral or beneficial effects. Initial clinical trials of antihypertensive regimens suggested that blood pressure lowering was the most important aspect of therapy and that the adverse effects on lipids and glucose tolerance did not impact clinical outcomes. Newer trials, however, question this finding and implicate these pleotropic effects as contributing to the results of the trials. Patients with cardiometabolic risk factors may have compelling indications for agents that inhibit the renin-angiotensin-aldosterone system, relegating diuretics and beta-blockers to third-line therapy.

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Effect of Thiazides on Carbohydrate Metabolism in Patients with Hypertension

Cited by 127 publications

References 13 publications

Guanethidine and Chlorthalidonein Hypertension

Guanethidine and Chlorthalidonein Hypertension

Influence of an angiotensin converting-enzyme inhibitor on diuretic-induced metabolic effects in hypertension.

Lipid Effects of Antihypertensive Medications

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