OBJECTIVE: To review the effectiveness of diuretic or beta-blocker-based treatment of hypertension in diabetic patients. RESEARCH DESIGN AND METHODS: A meta-analysis on individual patient data was performed on four trials of the treatment of hypertension in which diabetic patients were included and treated with first-line diuretics or beta-blockers. The main outcomes were the relative risk of death, fatal or nonfatal stroke, fatal or nonfatal coronary events, and major cardiovascular events. RESULTS: There were 92 diabetic patients who received first-line beta-blockers and 1,008 who received diuretics. In the control groups, diabetic patients had nearly twice the risk of any outcome when compared with nondiabetic patients. The same blood pressure reduction was achieved under treatment in the diabetic and nondiabetic patients, except for systolic pressure, which decreased more in the nondiabetic patients at 1 year. In the 15,843 nondiabetic patients, the risk of all four outcomes was reduced significantly in the treated group. In the 2,254 diabetic patients, the risk reduction was significant only for fatal and nonfatal stroke (36%, P = 0.011) and major cardiovascular events (20%, P = 0.032), but not for death (5%, P = 0.65) and fatal or nonfatal coronary events (15%, P = 0.23). However, no heterogeneity was detected between diabetic patients and nondiabetic patients for any outcome. The numbers of outcomes avoided for 1,000 patients treated for 5 years were higher in diabetic patients (e.g., 38 major cardiovascular events) than with nondiabetic patients (e.g., 28 major cardiovascular events). CONCLUSIONS: These results show that hypertensive diabetic patients benefit from first-line treatment with diuretics. No conclusion can be drawn for beta-blockers, owing to the small sample size.
OBJECTIVE: To review the effectiveness of diuretic or beta-blocker-based treatment of hypertension in diabeticpatients. RESEARCH DESIGN AND METHODS: A meta-analysis on individual patient data was performed on four trials of the treatment of hypertension in which diabeticpatients were included and treated with first-line diuretics or beta-blockers. The main outcomes were the relative risk of death, fatal or nonfatal stroke, fatal or nonfatal coronary events, and major cardiovascular events. RESULTS: There were 92 diabeticpatients who received first-line beta-blockers and 1,008 who received diuretics. In the control groups, diabeticpatients had nearly twice the risk of any outcome when compared with nondiabeticpatients. The same blood pressure reduction was achieved under treatment in the diabetic and nondiabeticpatients, except for systolic pressure, which decreased more in the nondiabeticpatients at 1 year. In the 15,843 nondiabeticpatients, the risk of all four outcomes was reduced significantly in the treated group. In the 2,254 diabeticpatients, the risk reduction was significant only for fatal and nonfatal stroke (36%, P = 0.011) and major cardiovascular events (20%, P = 0.032), but not for death (5%, P = 0.65) and fatal or nonfatal coronary events (15%, P = 0.23). However, no heterogeneity was detected between diabeticpatients and nondiabeticpatients for any outcome. The numbers of outcomes avoided for 1,000 patients treated for 5 years were higher in diabeticpatients (e.g., 38 major cardiovascular events) than with nondiabeticpatients (e.g., 28 major cardiovascular events). CONCLUSIONS: These results show that hypertensive diabeticpatients benefit from first-line treatment with diuretics. No conclusion can be drawn for beta-blockers, owing to the small sample size.
Authors: Carlos M Ferrario; Janae Joyner; Chris Colby; Alex Exuzides; Michael Moore; Debra Simmons; William Bestermann; Feride Frech-Tamas Journal: Vasc Health Risk Manag Date: 2013-07-22