Excess Mortality Associated With Diuretic Therapy in Diabetes Mellitus

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Diabetes mellitus (n=759). Intervention: Diuretic therapy vs. Untreated hypertension. Primary outcome: Cardiovascular mortality (RR 3.8, p=<0.001).

James H. Warram

doi:10.1001/archinte.1991.00400070114014

July 1, 1991Archives of Internal Medicine

Excess Mortality Associated With Diuretic Therapy in Diabetes Mellitus

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Key result

Diuretic therapy in diabetic patients was associated with a 3.8-fold higher risk of cardiovascular mortality compared to untreated hypertension.

Why the study?

Does diuretic therapy increase cardiovascular mortality in patients with diabetes and hypertension?

Key Points

Investigate whether high mortality in diabetic patients on antihypertensive therapy is due to treatment or associated risk factors.
Cohort analytic study with 759 participants enrolled in a clinical trial.
Median follow-up duration of 4.5 years with mortality reviews conducted by a committee.
Participants divided into groups based on blood pressure treatment regimens and evaluated for cardiovascular mortality.
Cardiovascular mortality was 3.8 times higher in patients treated with diuretics alone compared to untreated hypertensive patients (P<.001).
Higher mortality associated with diuretics was found despite the lowest blood pressure in that treatment group.
Caution advised regarding the use of diuretics in diabetic patients until a beneficial clinical trial is conducted.

Study Design

Type

Cohort (n=759)

Multicenter

Yes

Structured PICO

Does diuretic therapy increase cardiovascular mortality in patients with diabetes and hypertension?

P

Population

759 white outpatients aged 35 to 69 years with diabetes, severe retinopathy, and normal baseline serum creatinine, followed for a median of 4.5 years.

E

Exposure

Diuretics alone for the treatment of hypertension

C

Comparator

Untreated hypertension (patients were also classified into normotensive, treated by other agents alone, and treated by both agents)

O

Outcome

Cardiovascular mortalityhard clinical

Main Result

Relative Risk: 3.8

p-value: p=<0.001

In patients with diabetes, the use of diuretics alone to treat hypertension is associated with a nearly four-fold increase in cardiovascular mortality compared to untreated hypertension.

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Answers are grounded in this paper and cite their sources.

Implication

Caution advised with diuretic monotherapy in diabetic hypertension; leaves open whether RCTs will confirm this observational association.

Abstract

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Discussion

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Cite This Study

James H. Warram (1991) conducted a cohort in Diabetes mellitus (n=759). Diuretic therapy vs. Untreated hypertension was evaluated on Cardiovascular mortality (RR 3.8, p=<0.001). Diuretic therapy in diabetic patients was associated with a 3.8-fold higher risk of cardiovascular mortality compared to untreated hypertension.

synapsesocial.com/papers/6a2385639ed8aa0626a00e8c https://doi.org/10.1001/archinte.1991.00400070114014

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Excess Mortality Associated With Diuretic Therapy in Diabetes Mellitus

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Excess Mortality Associated With Diuretic Therapy in Diabetes Mellitus

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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