Rx lowers blood pressure with few adverse effects
Curb JD, Pressel SL, Cutler JA, et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. JAMA 1996; 276:1,886-1,892.
These investigators assessed the effect of low-dose, diuretic-based antihypertensive treatment on major cardiovascular disease event rates in older, noninsulin-dependent diabetic patients with isolated systolic hypertension compared with nondiabetic patients.
The double-blind, randomized and placebo-controlled trial evaluated 4,736 patients age 50 or older with isolated systolic hypertension; 583 were diabetic; 4,149 were not. The active treatment group received a low dose of chlorthalidone (12.5 to 25 mg/d) with a step-up to atenolol (25 to 50 mg/d) or reserpine (0.05 to 10 mg/d), if needed. The placebo group received a placebo and any active antihypertensive drugs prescribed by the patient’s private physician for persistently high-blood pressure.
The major outcome measures were five-year rates of major cardiovascular events, nonfatal plus fatal stroke, nonfatal myocardial infarction and fatal coronary heart disease, major coronary heart disease events, and all-cause mortality.
The anithypertensive drug regimen lowered blood pressure in both diabetic and nondiabetic patients with few adverse effects. All outcome rates were lower for both diabetic and nondiabetic patients randomized to the active treatment group than for patients randomized to the placebo group. Thus, the five-year major cardiovascular disease rate was lower by 34% for active treatment compared with placebo for diabetic and nondiabetic patients.
"Low-dose, diuretic-based [chlorthalidone] treatment is effective in preventing major cardiovascular disease events, cerebral and cardiac, in both noninsulin-treated diabetic and nondiabetic older patients with isolated systolic hypertension," the researchers conclude.
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