Low-dose diuretics beneficial in elderly with diabetes and ISH

THERAPY

Antihypertensive therapy with low-dose diuretics substantially reduces the 5-year risk of major cardiovascular events in elderly patients with isolated systolic hypertension (ISH). Risk reductions have been demonstrated in both non-insulin-treated patients with diabetes mellitus and patients without diabetes; however, the risk reduction in patients with diabetes was twice as great, with 101 events avoided per 1000 patients, compared with 51 per 1000 in patients without diabetes. These are the findings of the Systolic Hypertension in the Elderly Program (SHEP) Cooperative Research Group in the US.

In the SHEP trial, 4736 patients (mean age 71 years) with ISH were randomised to receive either active treatment or placebo. Active treatment involved low-dose chlorthalidone 12.5-25 mg/day, with the addition of atenolol or reserpine if needed. * At baseline, approximately 10% of patients reported a history of diabetes, and approximately half of these patients were receiving oral antihyperglycaemic medication. The study period was a minimum of 4 years (mean 4.5).

Important results The benefits reported, which included a trend

towards lower mortality from all causes, were due to the 'BP-lowering effects of diuretics', with no additional or independent benefits attributable to atenolol or reserpine, say the researchers. They note that there was 'little or no evidence' that adverse effects of treatment negated the 'important positive results' of the SHEP trial.

Although the researchers caution that this trial involved only a subset of all patients with diabetes, and that generalisation of the findings 'requires judgment' , they recommend that low-dose diuretic therapy 'should be strongly considered' as the first-choice treatment for systolic hypertension both for patients with non-insulin-treated diabetes mellitus and patients with glucose intolerance.

* See Inphanna 794: 10, 6JuJ 1991; Il26997

Curb m, Pressel SL, Cltle.- JA, Savage PJ, Applegate WB, et aI. Effect of diuretic-based antihypc:nensive treaIIIIent on cardiovascular disease risk in older diabetic patients with systolic hypertension. Journal of the American Medical Association 276: 1886-1892, 18 Dec 1996 _9207'

1173-832419711069-000171$01 .00° Adllintemational Limited 1997. All rights reserved

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Inpharma- 11 Jan 1997 No. 1069