[Diuretic therapy of hypertensives with Type 2 diabetes; rational therapy or malpractice?].
There is overwhelming evidence that effective antihypertensive therapy with diuretics reduces total mortality and cardiovascular morbidity. Therefore, diuretics have a well established place in the pharmacotherapy of hypertension. However, their role in the treatment of hypertensives with type-II-diabetes is a matter of controversy due to their potentially adverse effects on glucose-, lipid- and electrolyte metabolism which--in type-II-diabetics--may potentially offset the beneficial effects of blood pressure lowering. However, results of large-scale, prospective, randomised intervention trials demonstrate that in type-II-diabetics the beneficial effects of blood pressure reduction per se are more important than any potentially adverse effects on metabolic surrogate parameters. The reduction in total mortality and cardiovascular morbidity as a result of effective antihypertensive therapy is more pronounced in type-II-diabetics than in non-diabetics. This holds also true for a diuretic based antihypertensive therapy in type-II-diabetics. Clearly their effects on glucose-, lipid- and electrolyte metabolism are of minor, if any, clinical relevance. The hypertensive type-II-diabetic benefits from diuretics--they prolong life and improve its quality. Therefore, antihypertensive therapy with diuretics constitutes a rational pharmacotherapy founded on the principles of evidence based medicine and must not be considered as malpractice.
Schäfers
R F
RF
Abteilung für Nieren- und Hochdruckkrankheiten, Universitätsklinikum Essen. rafael.schaefers@uni-essen.de
Lütkes
P
P
Philipp
T
T
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D000075202:Contraindications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism* / Q000401:mortality; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D018149:Glucose Intolerance; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D050356:Lipid Metabolism; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate
D000959:Antihypertensive Agents; D001786:Blood Glucose; D004232:Diuretics