Diuretics boost outcome for metabolic syndrome

US research suggests NICE hypertension guidance is too narrow.

Diuretics are at least as effective as other hypertension drugs for improving clinical outcome in patients with the metabolic syndrome, US research claims.

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.

For the 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.

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 suggest that those with the metabolic syndrome should also be prescribed diuretics.

Lead researcher Dr Jackson Wright, from Case Western Reserve University in Ohio, said: 'These results confirm that for people with the metabolic syndrome, diuretics remain unsurpassed in preventing (negative) clinical outcomes.

'For black patients, especially those with the metabolic syndrome, this is a clear indication that diuretics are the treatment of choice.'

He added that calcium channel blockers were a reasonable alternative for patients intolerant to diuretics.

GPletters@haymarket.com

Arch Intern Med 2008; 168: 2-17, live links at www.healthcarerepublic.com.

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