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April 13, 1998Archives of Internal Medicine

Influence of Long-term, Low-Dose, Diuretic-Based, Antihypertensive Therapy on Glucose, Lipid, Uric Acid, and Potassium Levels in Older Men and Women With Isolated Systolic HypertensionThe Systolic Hypertension in the Elderly Program

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Why the study?

Does low-dose, diuretic-based antihypertensive therapy adversely alter glucose, lipid, uric acid, and potassium levels in older adults with isolated systolic hypertension?

Population

4,736 men and women aged 60 years and older with isolated systolic hypertension

Comparison

Stepwise antihypertensive therapy: step 1, 12.5… vs Matching placebo

Design

RCT, randomized, double-blind, placebo-controlled

Follow-up

3 years

Authors

PSPeter J. SavageBoston University

Discussion

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Implication

Diuretic-based therapy does not increase new diabetes cases in older adults; confirms metabolic safety for first-line hypertension use.

Key Points

  • This analysis aims to investigate the effects of long-term antihypertensive therapy on cardiovascular risk factors in older adults.
  • Community-based, multicenter, randomized, double-blind, placebo-controlled trial
  • Evaluated 4736 participants aged 60 and older over 3 years
  • Participants received low-dose chlorthalidone with possible adjuncts like atenolol or placebo.
  • Active treatment group had a greater reduction in blood pressure (13/4 mm Hg, P<.001) compared to placebo.
  • 8.6% of the active treatment group developed diabetes versus 7.5% in placebo (P=.25).
  • Active treatment increased fasting triglycerides (+0.9 mmol/L, P<.001) and uric acid (+35 micromol/L, P<.001), but with minimal effects on glucose and cholesterol.

Structured PICO

Does low-dose, diuretic-based antihypertensive therapy adversely alter glucose, lipid, uric acid, and potassium levels in older adults with isolated systolic hypertension?

P
Population
4,736 men and women aged 60 years and older with isolated systolic hypertension
I
Intervention
Stepwise antihypertensive therapy: step 1, 12.5 mg or 25.0 mg of chlorthalidone; step 2, addition of 25 mg or 50 mg of atenolol or reserpine
C
Comparator
Matching placebo
O
Outcome
Development of diabetes mellitus and changes in serum chemistry test results (glucose, lipids, uric acid, potassium) at 3 yearssurrogate

Low-dose chlorthalidone-based antihypertensive therapy in older adults with isolated systolic hypertension effectively lowers blood pressure with only mild effects on metabolic and electrolyte profiles.

Cite This Study

Peter J. Savage (1998) studied this question.

synapsesocial.com/papers/6a764587329619356706db51https://doi.org/10.1001/archinte.158.7.741

Topics

Hypertension management
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Do antihypertensive drugs precipitate diabetes in predisposed men?1989 · 120 citations
  2. 2Do antihypertensive drugs precipitate diabetes?1984 · 149 citations
  3. 3Diuretics and their side effects. Dilemma in the treatment of hypertension.1988 · 57 citations
  4. 4Diuretics, β-Blockers, and the Risk for Sudden Cardiac Death in Hypertensive Patients1995 · 121 citations
  5. 5Hypertension: Steps Forward and Steps Backward1993 · 53 citations