title: Effects of low dose versus conventional dose thiazide diuretic on insulin action in essential hypertension.
abstract: OBJECTIVE
  To see whether low dose thiazide diuretics given to patients with essential hypertension might avoid the adverse metabolic consequences seen with conventional doses.
  
  
  METHODS
  Double blind randomised crossover study of two 12 week treatment periods with either low dose (1.25 mg) or conventional dose (5.0 mg) bendrofluazide given after a six week placebo run in period.
  
  
  METHODS
  Outpatient clinics serving the greater Belfast area.
  
  
  METHODS
  16 white non-diabetic patients (9 male) under 65 with essential hypertension recruited from general practices within the greater Belfast area.
  
  
  METHODS
  Systolic and diastolic blood pressure and peripheral and hepatic insulin action.
  
  
  RESULTS
  One man failed to complete the study. There were no differences between doses in their effects on systolic and diastolic blood pressure. Bendrofluazide 1.25 mg had substantially less effect on serum potassium concentration than the 5.0 mg dose. There were no intertreatment differences in fasting glucose, insulin, cholesterol, and triglyceride concentrations. Bendrofluazide 5.0 mg significantly increased postabsorptive endogenous glucose production compared with baseline (mean 10.9 (SD 1.2) v 10.0 (0.8) mumol/kg/min), whereas bendrofluazide 1.25 mg did not. Postabsorptive endogenous glucose production was significantly higher with bendrofluazide 5.0 mg compared with 1.25 mg (10.9 (1.2) v 9.9 (0.8) mumol/kg/min) but was suppressed to a similar extent after insulin (bendrofluazide 5.0 mg 2.8 (1.5) mumol/kg/min v bendrofluazide 1.25 mg 2.2 (1.5) mumol/kg/min). Exogenous glucose infusion rates required to maintain euglycaemia were not significantly different between doses and were similar to baseline.
  
  
  CONCLUSIONS
  Bendrofluazide 1.25 mg is as effective as conventional doses but has less adverse metabolic effect. In contrast with conventional doses, low dose bendrofluazide has no effect on hepatic insulin action. There is no difference between low and conventional doses of bendrofluazide in their effect on peripheral insulin sensitivity.
authors: Sir George E Clark Metabolic Unit, Royal Victoria Hospital, Belfast.
authors: R
authors: R
authors: Harper
authors: C N
authors: CN
authors: Ennis
authors: B
authors: B
authors: Sheridan
authors: A B
authors: AB
authors: Atkinson
authors: G D
authors: GD
authors: Johnston
authors: P M
authors: PM
authors: Bell
mesh_terms: D001539:Bendroflumethiazide / Q000008:administration & dosage* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000378:metabolism* / Q000503:physiopathology; D007328:Insulin / Q000378:metabolism*; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000378:metabolism
chemical_list: D007328:Insulin; D001539:Bendroflumethiazide; D011188:Potassium