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Diuretics Diabetes

Should We Prescribe Diuretics For Patients With Prediabetes And Hypertension?

Should We Prescribe Diuretics For Patients With Prediabetes And Hypertension?

Should we prescribe diuretics for patients with prediabetes and hypertension? Should we prescribe diuretics for patients with prediabetes and hypertension? BMJ 2008; 337 doi: (Published 21 August 2008) Cite this as: BMJ 2008;337:a679 1Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand 1142 Correspondence to: B Arroll b.arroll{at}auckland.ac.nz The uncertainty arises from the findings of the large randomised controlled ALLHAT 2002 trial (31 512 people 55 years or older with hypertension and one other risk factor for cardiovascular disease), in which the thiazide-like diuretic chlortalidone seemed to increase some cardiac risk factors, including the rate of developing diabetes. After four years of follow-up in those who had a normal fasting blood glucose at baseline, 302 (11.6%) people taking chlortalidone, 154 (9.8%) of those taking amlodipine (a calcium channel blocker), and 119 (8.1%) of those taking lisinopril (an angiotensin converting enzyme inhibitor) had fasting blood glucose concentrations of 7 mmol/l (P<0.001).1 Diuretics are known to achieve long term cardiovascular results as good as, or better than, alternative antihypertensivesat least in people aged 55 years or older. But clinicians may not initially treat patients with prediabetes and hypertension with a diuretic because they worry that the induced diabetes might result in a worse outcome than if they prescribed a different class of antihypertensive. International guidelines give conflicting advice, presumably because of this uncertainty. The National Institute for Health and Clinical Excellence (NICE) advises general practitioners in the United Kingdom to use diuretics and calcium channel blockers as first line treatments in patients o Continue reading >>

Type 2 Diabetes And Thiazide Diuretics

Type 2 Diabetes And Thiazide Diuretics

Other Forms of Diabetes and Its Complications (JJ Nolan and H Thabit, Section Editors) In patients with prediabetes or type 2 diabetes, the use of thiazides as antihypertensive agents has been challenged because associated metabolic adverse events, including new-onset diabetes. These metabolic disturbances are less marked with low-dose thiazides and, in most but not all studies, with thiazide-like diuretics (chlorthalidone, indapamide) than with thiazide-type diuretics (hydrochlorothiazide). In post hoc analyses of subgroups of patients with hypertension and type 2 diabetes, thiazides resulted in a significant reduction in cardiovascular events, all-cause mortality, and hospitalization for heart failure compared to placebo and generally were shown to be non-inferior to other antihypertensive agents. Benefits attributed to thiazide diuretics in terms of cardiovascular event reduction outweigh the risk of worsening glucose control in type 2 diabetes and of new-onset diabetes in non-diabetic patients. Thiazides still play a key role in the management of patients with type 2 diabetes and hypertension. Cardiovascular diseaseDiureticHypertensionSGLT2 inhibitorThiazideType 2 diabetes This article is part of the Topical Collection on Other Forms of Diabetes and Its Complications This is a preview of subscription content, log in to check access No sources of funding were used to assist in the preparation of this manuscript. No conflicts of interest are directly relevant to the content of this manuscript. A.J. Scheen has received lecturer/scientific advisor/clinical investigator fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck Sharp & Dohme, NovoNordisk, Sanofi, and Servier. Human and Animal Rights and Informed Consent This article does not contain any stud Continue reading >>

Treatment Of Hypertension In Patients With Diabetes Mellitus

Treatment Of Hypertension In Patients With Diabetes Mellitus

INTRODUCTION AND PREVALENCE Hypertension is a common problem in patients with both type 1 and type 2 diabetes, but the time course in relation to the duration of diabetes is different [1-3]. Among those with type 1 diabetes, the incidence of hypertension rises from 5 percent at 10 years, to 33 percent at 20 years, and 70 percent at 40 years [1]. There is a close relation between the prevalence of hypertension and increasing albuminuria. The blood pressure typically begins to rise within the normal range at or within a few years after the onset of moderately increased albuminuria (the new term for what was previously called "microalbuminuria") [2] and increases progressively as the renal disease progresses. (See "Moderately increased albuminuria (microalbuminuria) in type 1 diabetes mellitus", section on 'Risk factors'.) These features were illustrated in a study of 981 patients who had type 1 diabetes for five or more years [3]. Hypertension was present in 19 percent of patients with normoalbuminuria, 30 percent with moderately increased albuminuria, and 65 percent with severely increased albuminuria (the new term for what was previously called "macroalbuminuria") [2]. The incidence of hypertension eventually reaches 75 to 85 percent in patients with progressive diabetic nephropathy [4]. The risk of hypertension is highest in blacks, who are also at much greater risk for renal failure due to diabetic nephropathy. (See "Overview of diabetic nephropathy".) The findings are different in patients with type 2 diabetes. In a series of over 3500 newly diagnosed patients, 39 percent were already hypertensive [5]. In approximately one-half of these patients, the elevation in blood pressure occurred before the onset of moderately increased albuminuria. Hypertension was strongly a Continue reading >>

Lower Blood Pressure, Higher Glucose?

Lower Blood Pressure, Higher Glucose?

I've read that hydrochlorothiazide can raise blood sugar levels. Is this true? My doctor prescribed it for my high blood pressure, but why would he do that if he knew it could raise my glucose levels? — Connie, Ohio The jury is still out regarding the long-term effect of hydrochlorothiazide on blood glucose because the results from studies have been mixed. While some studies have shown that there is indeed a higher risk of elevated glucose, others have not confirmed this finding. Here's what we know: Individuals who are taking thiazide diuretics, of which hydrochlorothiazide is one, can develop a mild case of elevated glucose, usually if their potassium levels are also low. When the potassium level normalizes, the glucose level goes back to normal. Thiazide diuretics have proven beneficial to people with high blood pressure and are among the best, safest, and least expensive of blood pressure drugs. The use of beta-blockers (which are also prescribed to treat high blood pressure) along with thiazide diuretics can, however, increase blood glucose levels. It is possible that hydrochlorothiazide increases the production of glucose from the liver, and because beta-blockers limit the absorption of glucose into cells, the use of these medicines in tandem can raise glucose levels significantly enough to cause diabetes. My recommendation is this: Make sure your potassium level is normal or high-normal when taking hydrochlorothiazide. If your doctor tells you that your levels are low, eating bananas — which are rich in potassium — can help. And, unless absolutely necessary, avoid mixing beta-blockers with hydrochlorothiazide. Your best bet is to visit your doctor. Ask him to explain the benefits and risks of taking hydrocholorthiazide versus some other antihypertensive dru Continue reading >>

Type 2 Diabetes And Thiazide Diuretics | Diabetes.medicinematters.com

Type 2 Diabetes And Thiazide Diuretics | Diabetes.medicinematters.com

02-05-2018 | Cardiovascular disorders | Review | Article In patients with prediabetes or type 2 diabetes, the use of thiazides as antihypertensive agents has been challenged because associated metabolic adverse events, including new-onset diabetes. These metabolic disturbances are less marked with low-dose thiazides and, in most but not all studies, with thiazide-like diuretics (chlorthalidone, indapamide) than with thiazide-type diuretics (hydrochlorothiazide). In post hoc analyses of subgroups of patients with hypertension and type 2 diabetes, thiazides resulted in a significant reduction in cardiovascular events, all-cause mortality, and hospitalization for heart failure compared to placebo and generally were shown to be non-inferior to other antihypertensive agents. Benefits attributed to thiazide diuretics in terms of cardiovascular event reduction outweigh the risk of worsening glucose control in type 2 diabetes and of new-onset diabetes in non-diabetic patients. Thiazides still play a key role in the management of patients with type 2 diabetes and hypertension. Please log in to get access to this content Continue reading >>

Diuretics May Increase Diabetes Risk By Lowering Blood Potassium Levels

Diuretics May Increase Diabetes Risk By Lowering Blood Potassium Levels

Diuretics may increase diabetes risk by lowering blood potassium levels Posted on Nov 25, 2008, 6 a.m. By Rich Hurd New research suggests that depleted blood potassium levels could help to explain why people prescribed diuretics for the treatment of high blood pressure are at increased risk of type 2 diabetes. New research suggests that depleted blood potassium levels could help to explain why people prescribed diuretics for the treatment of high blood pressure are at increased risk of type 2 diabetes. Tariq Shafi and colleagues examined data from 3,790 non-diabetic participants in the Systolic Hypertension in Elderly Program (SHEP), a study designed to determine the risk versus benefit of treating people age 60 years or older with the thiazide diuretic chlorthalidone. Previous research has shown that treatment with thiazide diuretics causes potassium levels to drop and increases patients' risk of developing type 2 diabetes by as much as 50%, although whether the drop in blood potassium was linked to the increased risk of diabetes was uncertain. Results of this study suggest that the increased risk of type 2 diabetes associated with thiazide diuretics is indeed linked to their action on blood potassium levels. In fact, results showed that for each 0.5 milliequivalent-per-liter (MEq/L) decrease in serum potassium, there was a 45% increased risk of diabetes . Thiazides are effective at treating high blood pressure and are inexpensive, however their association with diabetes has led many doctors to prescribe other, more expensive, drugs. However, according to Dr Shafi, the study findings suggest that thiazides can be used safely as long as doctors monitor and regulate blood potassium levels. The authors speculate that potassium supplement may prevent thiazide-induced diab Continue reading >>

'water Pills' May Cut Heart Risks In Diabetes

'water Pills' May Cut Heart Risks In Diabetes

'Water Pills' May Cut Heart Risks in Diabetes Study: More Costly Drugs No Better Than Diuretics June 27, 2005 -- Water pills may work as well as other commonly used high blood pressure pills to protect the hearts of people with type 2 diabetes . The researchers say they found "no evidence" that newer, more costly high blood pressure medications were better at preventing heart disease deaths or heart attacks than water pills, also called diuretics. The findings were complex and "must be interpreted with caution," they write in the Archives of Internal Medicine. They say the type of diuretics they studied "should be strongly considered" as initial drug therapy for patients with high blood pressure and type 2 diabetes or prediabetes . Nearly one in three U.S. adults has high blood pressure . But almost a third of them don't know it, says the American Heart Association (AHA). High blood pressure affects nearly 50 million people in the U.S. and approximately 1 billion worldwide, according to the National Heart, Lung and Blood Institute (NHLBI). Uncontrolled high blood pressure can be very dangerous. It can raise the risk of heart attack , stroke , heart failure , or kidney failure , says the AHA. The relationship between blood pressure and heart disease risk is a continuous and consistent one, says the NHLBI. The higher the blood pressure, the greater the risk of heart attack , heart failure, stroke , and kidney disease . People with diabetes and high blood pressure have approximately twice the risk of complications compared with people who have high blood pressure alone. Medications can help curb high blood pressure and reduce the risk of complications from the disease. A healthy lifestyle -- including exercise and good nutrition -- can also make a difference. "Almost thre Continue reading >>

Diuretics Best Option For Diabetics With High Blood Pressure

Diuretics Best Option For Diabetics With High Blood Pressure

MONDAY, June 27, 2005 (HealthDayNews) -- For people with type 2 diabetes and high blood pressure, cheaper diuretic medications may be the most cost-effective option in reducing hypertension, a major new study finds. "Diuretics are the optimal choice for initial therapy," said lead author Dr. Paul K. Whelton, senior vice president for health sciences at Tulane University. Newer, more expensive drugs "did not perform better in reducing heart attacks or death from heart disease," Whelton added. "Diuretics are the appropriate first choice, not only for people who don't have any indication of diabetes, but for people with diabetes or prediabetes." The finding is based on data collected as part of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the largest clinical trial on high blood pressure ever conducted. The report appears in the June 27 issue of the Archives of Internal Medicine. In their study, Whelton and his team collected data on more than 31,500 adults aged 55 and older. All of the participants had high blood pressure and at least one other condition putting them at risk for heart disease. The study included over 13,100 people with type 2 diabetes, nearly 1,400 people with high blood sugar (pre-diabetes) and more than 17,000 people with normal blood sugar levels. The researchers compared the benefits of three drug types in controlling blood pressure in these individuals: a diuretic; another type of drug called a calcium channel blocker; and a third type, an angiotensin-converting enzyme inhibitor (ACE inhibitor). They found no significant difference between the drugs in controlling blood pressure in any group when used as initial treatment. Based on these findings, Whelton believes that for most people with high blood pres Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Diabetes insipidus (DI) is a condition characterized by large amounts of dilute urine and increased thirst.[1] The amount of urine produced can be nearly 20 liters per day.[1] Reduction of fluid has little effect on the concentration of the urine.[1] Complications may include dehydration or seizures.[1] There are four types of DI, each with a different set of causes.[1] Central DI (CDI) is due to a lack of the hormone vasopressin (antidiuretic hormone).[1] This can be due to damage to the hypothalamus or pituitary gland or genetics.[1] Nephrogenic diabetes insipidus (NDI) occurs when the kidneys do not respond properly to vasopressin.[1] Dipsogenic DI is due to abnormal thirst mechanisms in the hypothalamus while gestational DI occurs only during pregnancy.[1] Diagnosis is often based on urine tests, blood tests, and the fluid deprivation test.[1] Diabetes mellitus is a separate condition with an unrelated mechanism, though both can result in the production of large amounts of urine.[1] Treatment involves drinking sufficient fluids to prevent dehydration.[1] Other treatments depend on the type.[1] In central and gestational disease treated is with desmopressin.[1] Nephrogenic disease may be treated by addressing the underlying cause or the use of a thiazide, aspirin, or ibuprofen.[1] The number of new cases of diabetes insipidus each year is 3 in 100,000.[4] Central DI usually starts between the ages of 10 and 20 and occurs in males and females equally.[2] Nephrogenic DI can begin at any age.[3] The term "diabetes" is derived from the Greek word meaning siphon.[5] Signs and symptoms[edit] Excessive urination and extreme thirst and increased fluid intake (especially for cold water and sometimes ice or ice water) are typical for DI.[6] The symptoms of excessive urination Continue reading >>

Efficacy Of Diuretics And Beta-blockers In Diabetic Hypertensive Patients

Efficacy Of Diuretics And Beta-blockers In Diabetic Hypertensive Patients

-Blockers in Diabetic Hypertensive Patients OBJECTIVE To review the effectiveness of diuretic or -blockerbased treatment of hypertension in diabetic patients. RESEARCH DESIGN AND METHODS A meta-analysis on individual patient data was performed on four trials of the treatment of hypertension in which diabetic patients were included and treated with first-line diuretics or -blockers. The main outcomes were the relative risk of death, fatal or nonfatal stroke, fatal or nonfatal coronary events, and major cardiovascular events. RESULTS There were 92 diabetic patients who received first-line -blockers and 1,008 who received diuretics. In the control groups, diabetic patients had nearly twice the risk of any outcome when compared with nondiabetic patients. The same blood pressure reduction was achieved under treatment in the diabetic and nondiabetic patients, except for systolic pressure, which decreased more in the nondiabetic patients at 1 year. In the 15,843 nondiabetic patients, the risk of all four outcomes was reduced significantly in the treated group. In the 2,254 diabetic patients, the risk reduction was significant only for fatal and nonfatal stroke (36%, P = 0.011) and major cardiovascular events (20%, P = 0.032), but not for death (5%, P = 0.65) and fatal or nonfatal coronary events (15%, P = 0.23). However, no heterogeneity was detected between diabetic patients and nondiabetic patients for any outcome. The numbers of outcomes avoided for 1,000 patients treated for 5 years were higher in diabetic patients (e.g., 38 major cardiovascular events) than with nondiabetic patients (e.g., 28 major cardiovascular events). CONCLUSIONS These results show that hypertensive diabetic patients benefit from first-line treatment with diuretics. No conclusion can be drawn for -bl Continue reading >>

Type 2 Diabetes And Thiazide Diuretics.

Type 2 Diabetes And Thiazide Diuretics.

Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Lige, University of Lige, CHU Sart Tilman (B35), B-4000, Liege, Belgium. [email protected] More 1.Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Lige, University of Lige, CHU Sart Tilman (B35), B-4000, Liege, Belgium. [email protected] Current Diabetes Reports [05 Feb 2018, 18(2):6] In patients with prediabetes or type 2 diabetes, the use of thiazides as antihypertensive agents has been challenged because associated metabolic adverse events, including new-onset diabetes.These metabolic disturbances are less marked with low-dose thiazides and, in most but not all studies, with thiazide-like diuretics (chlorthalidone, indapamide) than with thiazide-type diuretics (hydrochlorothiazide). In post hoc analyses of subgroups of patients with hypertension and type 2 diabetes, thiazides resulted in a significant reduction in cardiovascular events, all-cause mortality, and hospitalization for heart failure compared to placebo and generally were shown to be non-inferior to other antihypertensive agents. Benefits attributed to thiazide diuretics in terms of cardiovascular event reduction outweigh the risk of worsening glucose control in type 2 diabetes and of new-onset diabetes in non-diabetic patients. Thiazides still play a key role in the management of patients with type 2 diabetes and hypertension. Continue reading >>

Drugs That Can Worsen Diabetes Control

Drugs That Can Worsen Diabetes Control

One of the main goals of any diabetes control regimen is keeping blood glucose levels in the near-normal range. The cornerstones of most plans to achieve that goal include following a healthy diet, getting regular exercise, and taking insulin or other medicines as necessary. However, it’s not uncommon for people with diabetes to have other medical conditions that also require taking medicines, and sometimes these drugs can interfere with efforts to control blood glucose. A few medicines, including some commonly prescribed to treat high blood pressure and heart disease, have even been implicated as the cause of some cases of diabetes. This article lists some of the medicines that can worsen blood glucose control, the reasons they have that effect, the usual magnitude of the blood glucose changes, as well as the pros and cons of using these drugs in people who have diabetes. Where the problems occur To understand how various medicines can worsen blood glucose control, it helps to understand how insulin, the hormone responsible for lowering blood glucose, works in the body. Insulin is released from the beta cells of the pancreas in response to rising levels of glucose in the bloodstream, rising levels of a hormone called GLP-1 (which is released from the intestines in response to glucose), and signals from the nerve connections to the pancreas. The secretion of insulin occurs in two phases: a rapid first phase and a delayed second phase. Both of these phases are dependent on levels of potassium and calcium in the pancreas. Insulin acts on three major organs: the liver, the muscles, and fat tissue. In the liver, insulin enhances the uptake of glucose and prevents the liver from forming new glucose, which it normally does to maintain fasting glucose levels. In muscle and f Continue reading >>

Risk Of Diabetes And Diuretics

Risk Of Diabetes And Diuretics

Chicago, IL - Results from a six-month extension study have shown that impairment in glycemic control after one year of diuretic-based combination treatment is reversible by switching to treatment not involving a diuretic, in this case, an ACE inhibitor and calcium-channel blocker [ 1 ]. "When we looked at who developed new-onset diabetes, the plan was to then switch these patients over to the ACE-inhibitor/calcium-channel-blocker combination to see whether we could regress or bring back to baseline these metabolic changes," lead investigator Dr George Bakris (University of Chicago, IL) told heart wire . "This effect of new-onset diabetes, at least if you intervene within a short time of starting the therapy, does not appear to be permanent." The hypothesis-generating study, an extension of the Study of Trandolapril/Verapamil SR And Insulin Resistance (STAR), was presented earlier this week at the American Society of Hypertension 2007 Scientific Sessions. In the original STAR study, published in 2006, investigators showed that in patients with impaired glucose tolerance, normal kidney function, and hypertension, the fixed-dose combination of trandolapril and verapamil reduces the risk of new-onset diabetes compared with a losartan/hydrochlorothiazide-based therapy. Speaking with heart wire , Bakris said clinicians previously believed marrying diuretic therapy to an ACE inhibitor or angiotensin receptor blocker (ARB) might provide protection from new-onset diabetes, although this turned out not to be true. The risk of new-onset diabetes is also dose dependent, he said, such that at 25-mg hydrochlorothiazide (HCTZ) there is substantial risk of impairing the glucose response. Testing the hypothesis that impaired glycemic control might be reversible early in the diuretic/l Continue reading >>

Drug Induced Diabetes

Drug Induced Diabetes

Tweet A number of medications have side effects which include the raising of blood glucose levels. Drug induced diabetes is when use of a specific medication has lead to the development of diabetes. In some cases the development of diabetes may be reversible if use of the medication is discontinued, but in other cases drug-induced diabetes may be permanent. Drug induced diabetes is a form of secondary diabetes, in other words diabetes that is a consequence of having another health condition. Which drugs can induce diabetes? A number of drugs have been linked with an increased risk development of type 2 diabetes. Corticosteroids Thiazide diuretics Beta-blockers Antipsychotics Is diabetes permanent? Diabetes may not be permanent but this can depend on other health factors. With some medications, blood glucose levels may return back to normal once the medication is stopped but, in some cases, the development of diabetes may be permanent. Managing drug induced diabetes If you need to continue taking the medication that has brought on diabetes, it may make your diabetes more difficult to control than would otherwise be the case. If you are able to stop the course of medication, you may find your blood glucose levels become slightly easier to manage. Following a healthy diet and meeting the recommended exercise guidelines will help to improve your chances of managing your blood glucose levels. Can drug induced diabetes be prevented? It may be possible to reduce the risk of developing diabetes by ensuring you to keep to a healthy lifestyle whilst you are on the medication. Being on smaller doses of the medication or shorter periods of time may help to reduce the likelihood of developing high blood sugar levels and diabetes. Doctors will usually try to put you on the smallest e Continue reading >>

Controlling Hypertension In Patients With Diabetes

Controlling Hypertension In Patients With Diabetes

Hypertension and diabetes mellitus are common diseases in the United States. Patients with diabetes have a much higher rate of hypertension than would be expected in the general population. Regardless of the antihypertensive agent used, a reduction in blood pressure helps to prevent diabetic complications. Barring contraindications, angiotensin-converting enzyme inhibitors are considered first-line therapy in patients with diabetes and hypertension because of their well-established renal protective effects. Calcium channel blockers, low-dose diuretics, beta blockers, and alpha blockers have also been studied in this group. Most diabetic patients with hypertension require combination therapy to achieve optimal blood pressure goals. Nearly one in four adults in the United States has hypertension, and more than 10 million adults have diabetes.1 Moreover, hypertension is twice as common in persons with diabetes as it is in others.2 Obesity may be a common link between the two disorders, but other factors such as insulin resistance3 and autonomic dysfunction4 may also be involved. Excess weight with truncal obesity, hypertension, impaired glucose tolerance, insulin resistance, and dyslipidemia are among the components of the metabolic syndrome, which has been associated with an increased risk of coronary heart disease.5 In general, only 25 percent of patients with hypertension have adequate control of their blood pressure.6 Blood pressure goals are lower, and thus more difficult to achieve, in patients who also have diabetes. Elevated blood pressure is known to contribute to diabetic microvascular and macrovascular complications (Table 1).4,7,8 Fortunately, reductions in blood pressure can decrease the risk of these complications.8 TABLE 1 Microvascular complications Renal d Continue reading >>

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