Preventing new-onset diabetes in thiazide-treated patients
Key result
The combination of amiloride and hydrochlorothiazide significantly reduced 2-hour blood glucose concentrations compared with hydrochlorothiazide monotherapy (MD -0.42 mmol/L; 95% CI -0.84 to -0.004; P=0.048).
Why the study?
Does amiloride or amiloride plus hydrochlorothiazide prevent glucose intolerance and improve blood pressure compared to hydrochlorothiazide alone in patients with hypertension?
Population
Patients with hypertension
Comparison
Amiloride or combination of hydrochlorothiazide… vs Hydrochlorothiazide, with dose doubled after 12…
Design
Editorial, randomly assigned, double-blind
Follow-up
24 weeks
Authors
Discussion
Loading...
Member takes
Implication
The combination of amiloride with hydrochlorothiazide prevents glucose intolerance and improves blood pressure control compared with monotherapy, supporting its potential as a first-line treatment for hypertension.
Structured PICO
Does amiloride or amiloride plus hydrochlorothiazide prevent glucose intolerance and improve blood pressure compared to hydrochlorothiazide alone in patients with hypertension?
P
Population
Several hundred patients with hypertension treated for 24 weeks.
I
Intervention
Amiloride (10 mg daily) or combination of hydrochlorothiazide and amiloride (12.5 mg and 5 mg daily), with all doses doubled after 12 weeks
C
Comparator
Hydrochlorothiazide (25 mg daily), with dose doubled after 12 weeks
O
Outcome
2 h blood glucose concentrations on oral glucose tolerance tests at 12 and 24 weekssurrogate
Main Result
Mean Difference: -0.42 (95% CI -0.84–-0.004)
p-value: p=0.048
The combination of amiloride with hydrochlorothiazide prevents glucose intolerance and improves blood pressure control compared with monotherapy, supporting its potential as a first-line treatment for hypertension.
Limitations
- A study with longer treatment duration than 24 weeks would be useful to ensure that the favourable metabolic effects of amiloride continue to prevail.
- Direct quantification of diabetes development in patients given a thiazide diuretic compared with those given a thiazide-amiloride combination is needed.
- Long-term studies are needed to clarify previous discrepancies and provide conclusive evidence that the diabetes induced by antihypertensive drugs has the same deleterious effects on macrovascular and microvascular disease as spontaneous diabetes.
- Short treatment duration of 24 weeks
- Relies on 2 h glucose concentrations rather than direct quantification of diabetes development
- Lack of long-term studies to clarify if drug-induced diabetes has the same deleterious effects as spontaneous diabetes
Cite This Study
Giuseppe Mancia (2015) conducted an editorial in hypertension. Amiloride plus hydrochlorothiazide vs. Hydrochlorothiazide monotherapy (25 mg daily, doubled after 12 weeks) was evaluated on 2 h blood glucose concentrations (MD -0.42 mmol/L, 95% CI -0.84 to -0.004, p=0.048). The combination of amiloride and hydrochlorothiazide significantly reduced 2-hour blood glucose concentrations compared with hydrochlorothiazide monotherapy (MD -0.42 mmol/L; 95% CI -0.84 to -0.004; P=0.048).