Metabolic effects of lisinopril versus hydrochlorothiazide plus amiloride in essential hypertension

BACKGROUND: Prior meta-analyses measuring thiazideinduced glycemic change have demonstrated an increased risk of incident diabetes; however, this measure's definition has changed over time. AIM: To determine the magnitude of change in fasting plasma glucose (FPG) for thiazide diuretics. DATA SOURCES: A research librarian designed and conducted searches in Medline®, EMBASE, and EBM Reviews-Cochrane Central Register of Controlled Trials (inception through July 2018) and International Pharmaceutical Abstracts (inception to December 2014). STUDY SELECTION: Randomized, controlled trials comparing a thiazide or thiazide-like diuretic to any comparator reporting FPG were identified. Trials enrolling < 50 participants, those with a follow-up period of < 4 weeks, and conference abstracts were excluded. DATA EXTRACTION: Independent duplicate screening of citations and full-text articles, data extraction, and assessment of risk of bias was conducted. DATA SYNTHESIS: Ninety-five studies were included (N = 76,608 participants), with thiazides compared with placebo, beta-blockers, calcium channel blockers, reninangiotensin-aldosterone-system inhibitors, potassiumsparing diuretic, and others alone or in combination. Thiazide diuretics marginally increased FPG (weighted mean difference 0.20 mmol/L (95% CI 0.15-0.25); I 2 = 84%) (1 mmol/L = 18 mg/dL). Results did not change substantially when considering dose or duration, comparing thiazides with placebo or an active comparator, or using thiazides as monotherapy or combination therapy, even when combined with a potassium-correcting agent. CONCLUSION: Thiazide diuretics have a small and clinically unimportant impact on FPG.

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Thiazide Diuretic–Induced Change in Fasting Plasma Glucose: a Meta-analysis of Randomized Clinical Trials

Hall

Eurich

Nagy

et al. 2020

J GEN INTERN MED

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Lisinopril and hydrochlorothiazide/amiloride: A comparative study in the treatment of patients with mild-to-moderate hypertension

Barnes¹

1994

Current Therapeutic Research

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Metabolic effects of lisinopril versus hydrochlorothiazide plus amiloride in essential hypertension

Cited by 2 publications

References 33 publications

Thiazide Diuretic–Induced Change in Fasting Plasma Glucose: a Meta-analysis of Randomized Clinical Trials

Thiazide Diuretic–Induced Change in Fasting Plasma Glucose: a Meta-analysis of Randomized Clinical Trials

Lisinopril and hydrochlorothiazide/amiloride: A comparative study in the treatment of patients with mild-to-moderate hypertension

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