Usage of diuretics among diabetic-hypertensive patients

Abstract

Background: Hypertension is more common in diabetics than in non-diabetic patients. An aggressive approach to the diagnosis and treatment of hypertension in patients with diabetes is required in order to substantially reduce the incidence of both macro-vascular and microvascular complications. The role of diuretics in the treatment of hypertension as fi rst line or second line drugs is a provoking debate, hence we studied the usage of diuretics and their effects on BP and glycemic control among diabetic-hypertensive patients. Methods: This cross sectional study was carried out for a period of six months in a tertiary care teaching hospital. Patients' details such as age, gender, height, weight, comorbid diseases, blood pressure, eGFR along with duration of diabetes and hypertension and drugs prescribed for hypertension were noted. Data were analyzed using descriptive statistics. Results: A total of 336 diabetic-hypertensives with a mean age of 64.55±9.51 years were included. Fortyfi ve patients were on diuretics,two (4.4%) of whom were on diuretic monotherapy, 16 (35.6%) on two drug combinations (Diuretic + ACEI or ARB), 21 (46.7%) on three drug combinations (diuretics + ARB & BBs or diuretic + ACEI & BB or diuretic + ARB &CCB) and six (13.3%) were on four drug combinations (diuretics + ARB, CCB & BB). Among the patients on diuretic combination therapy BP was well controlled in 23 (51%) patients and the glycemic control was comparable to those not on diuretics. Conclusion: In the present study the usage of diuretics was consistent with the guidelines. About 13% of diabetic-hypertensive patients were on diuretic treatment. The control of BP in patients on diuretics was not satisfactory, but there was no worsening of glycemic control compared to other antihypertensive therapy. This shows that low dose thiazides in combination with other antihypertensives can be safe in diabetic-hypertensive patients however their effi cacy needs further scrutiny.

Prescribing patterns of antihypertensive medications: A systematic review of literature between 2010 and 2020

“…, 32. , 33 , 36 , 39 , 42 , 50 , 53 while 10 studies were conducted in outpatient clinics. 14 , 22 , 27.…”

“…The predominant study design utilized by most studies was cross-sectional design ( n = 16) 14 , 17 , 22 , 26 , 27 , 31 , 33 , 36 , 37 , 39 , 42 , 44 , 47 , 49 , 51 , 53 followed by 11 retrospective studies. 15 , 16 , 19 , 24 , 25 , 30 , 34 , 35 , 38 , 45 , 52 Ten studies adopted a prospective study design.…”

“…The number of study participants in included studies ranged from 100 patients 41 to 140,126 patients. 45 Four studies specifically targeted patients with type 2 diabetes 29 , 33 , 39 , 48 and one study included patients with diabetes and those with IHD. 47 One study targeted patients with resistant hypertension.…”

“…Fourteen studies assessed the prescribing patterns of antihypertensive medications among hypertensive patients with diabetes. 23 , 25 , 30 , 33 , 37 , 39 , 41 , 42 , 47 , 48 , 50 , 52 , 53 Eight studies reported ACEIs/ARBs as the most commonly used antihypertensives as monotherapy. 23 , 25 , 26 , 30 , 37 , 39 , 47 , 48 The percentage of diabetic patients on monotherapy varied from 25.0% 47 to 71.8%.…”

“…23 , 25 , 26 , 30 , 37 , 39 , 47 , 48 The percentage of diabetic patients on monotherapy varied from 25.0% 47 to 71.8%. 30 Seven studies reported the most commonly used antihypertensives as dual therapy 23 , 25 , 26 , 33 , 37 , 39 , 48 with (ACEIs/ARBs+CCBs) being the most common combination in five studies. 23 , 25 , 26 , 37 , 48 Five studies reported the percentage of diabetic patients on dual therapy 30 , 33 , 37 , 39 , 42 with percentages ranging from 24.8% 30 to 65.0%.…”