'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.
About High Blood Pressure
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
Uncontrolled high blood pressure can be very dangerous. It can raise the
risk of heart attack, stroke, heart failure, or kidney failure, says the
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
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.
High Blood Pressure and Diabetes
"Almost three out of every four persons with type 2 diabetes has [high
blood pressure]," says Paul Whelton, MD, MSc, in a news release.
That puts those people at "substantial risk" for heart disease, he
Whelton worked on the diuretic study. He is Tulane University's senior vice
president for health sciences.
Whelton's study included more than 31,500 adults aged 55 and older.
All had high blood pressure and at least one other heart disease risk
factor. More than 13,000 had type 2 diabetes or an abnormal fasting blood
Patients were assigned to take one of three drugs initially:
- A diuretic called chlorthalidone
- An ACE inhibitor called lisinopril (Prinivil or Zestril)
- A calcium channel blocker called Norvasc
They were tracked for five years, on average. Most people with diabetes and
high blood pressure require more than one drug to achieve a target blood
pressure goal of less than 130/80.
Whelton's findings include:
- The ACE inhibitor and calcium channel blocker were not better than the
diuretic in preventing heart disease death or nonfatal heart attacks.
- More stroke protection for black patients taking the diuretic than the ACE
inhibitor, regardless of diabetes.
- Heart failure was less common in those taking the diuretic, with or without
diabetes. The difference in heart failure with the ACE inhibitor was very
- Systolic blood pressure (the first number in a blood pressure reading when
the heart beats) was lower with diabetes patients taking the diuretic.
According to the NHLBI, if left uncontrolled, high systolic pressure can lead
to stroke, heart attack, heart failure, kidney damage, blindness, or other
conditions. Systolic blood pressure becomes more important as people get
- Diastolic blood pressure (the second or lower number of the blood pressure
reading, when the heart rests in between beats) was lower in diabetes patients
taking the calcium channel blocker. The diastolic blood pressure is especially
important for younger people. The higher the diastolic blood pressure, the
greater the risk for heart attacks, strokes, and kidney failure, writes the