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Will thiazide diuretics increase my chances of getting diabetes?

Q. Thiazide diuretics are often recommended as the first medication to use to control blood pressure, but I've heard that a large study called ALLHAT found an association between thiazide diuretics and diabetes. Is this something to be concerned about?

A. You're right about thiazide diuretics being the first choice if you need to take a drug to bring high blood pressure under control. National guidelines recommend them as initial therapy for most people with hypertension (high blood pressure), although often more than one medication will be needed to bring blood pressure under control. Numerous studies have shown that thiazide diuretics are effective for preventing heart attacks, strokes, and other cardiovascular consequences of hypertension, and reducing the risk of those complications makes control of hypertension so important. In this country, hydrochlorothiazide is the most commonly prescribed thiazide diuretic.

The ALLHAT study you mention is probably the most influential study of blood pressure medication ever conducted. The study included 33,000 people who were randomized to take one of three blood pressure-lowering medications: a thiazide diuretic, a calcium-channel blocker, or an ACE inhibitor. The rate of heart attacks and deaths from heart disease was similar in all three groups, but the thiazide group had a lower rate of heart failure.

Researchers analyzed that ALLHAT data to see how the three different medications affected blood sugar levels. They found that all three were associated with an increase in blood sugar, but more people in the thiazide group (11.6%) were diagnosed with diabetes than those assigned to take the calcium-channel blocker (9.8%) or the ACE inhibitor (8.1%). This modest difference in the risk for developing diabetes did not, however, translate into more heart attacks or other problems. So, on balance, the benefits of thiazide diuretics--controlling and preventing hypertension-associated events--outweigh the risk of developing diabetes.

I think the thiazide diuretics remain an excellent first choice for most people with high blood pressure, and the small increased risk of developing diabetes seen in the ALLHAT study shouldn't deter patients from taking them or physicians from prescribing them.

-- Nancy Keating, MD Brigham and Women's Hosptal, Boston Reprinted from Healthbeat, Harvard Medical School Publications, May 2010
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Title Annotation:ask the experts
Author:Keating, Nancy
Publication:AMT Events
Article Type:Interview
Date:Sep 1, 2011
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