The National Electronic Library for Medicines has reported on two recent papers regarding hypertension.
Circulation has published an analysis of the ALLHAT study and each of the study medications preventative effects on heart failure. This paper found that diuretics were better than calcium channels blockers at preventing heart failure. Diuretics were also superior to ACE Inhibitors in the short term.
Diabetes Care has published the results of a prospective cohort study into the association between different antihypertensive agents and the development of diabetes. There is also an editorial to accompany this paper. The paper concludes that thiazide diuretics and beta-blockers are associated with an increased risk of diabetes and therefore patients on these drugs should be monitored more closely.
The editorial questions if the increased risks of developing diabetes detracts from the cardiovascular benefits. ALLHAT for example compared chlorthalidone, lisinopril and amlodipine, all of these drugs reduced cardiovascular outcomes to a similar extent despite chlorthalidone being associated with higher rates of new-onset diabetes.
Action: This new information will be of interest to clinicians treating hypertension. The NICE Guidance on Hypertension is expected this month and changing current practice at this stage would be unwise.
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