The findings go against previous assumptions that ACE inhibitors, alpha-blockers and calcium channel blockers are preferable to diuretics because of their better metabolic profile.
Study data on 42,418 patients with hypertension and at least one other cardiovascular risk factor was reviewed to determine the efficacy of thiazide diuretics in patients with the metabolic syndrome.
Of the 23,077 participants with the metabolic syndrome those on an ACE inhibitor, alpha blocker or calcium-channel blocker had higher rates of heart failure and combined cardiovascular disease than those given the diuretic. This trend was even more marked among black patients.
The findings support the inclusion of diuretics in the final NICE guideline on hypertension published in 2006. Diuretics did not feature in the draft version of the guideline, but after consultation were recommended for black patients and those over 55.
But the latest findings do suggest that those with the metabolic syndrome should also be prescribed diuretics.
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