A Double-Blind, Placebo-Controlled, Crossover Trial Comparing the Effects of Amiloride and Hydrochlorothiazide on Glucose Tolerance in Patients With Essential Hypertension
Stears AJ et al. – No impairment was seen with K+–sparing diuretic or β1–selective blockade. Substitution or addition of amiloride may be the solution to preventing thiazide–induced diabetes mellitus.
Two double–blind, placebo–controlled, crossover studies were performed.
In study 1 (41 patients), the authors found that changes in glucose during a 2–hour oral glucose tolerance test could be detected after 4 weeks of treatment with bendroflumethiazide.
In study 2, 37 patients with essential hypertension received, in random order, 4 weeks of once–daily treatment with hydrochlorothiazide (HCTZ) 25 to 50 mg, nebivolol 5 to 10 mg, combination (HCTZ 25–50 mg+nebivolol 5–10 mg), amiloride (10–20 mg), and placebo.
Each drug was force titrated at 2 weeks and separated by a 4–week placebo washout.
At each visit, the authors recorded blood pressure and performed a 75–g oral glucose tolerance test.
Primary outcome was the difference in glucose (over the 2 hours of the oral glucose tolerance test) between 0 and 4 weeks, when HCTZ and amiloride were compared by repeated–measures analysis.
For similar blood pressure reductions, there were opposite changes in glucose between the 2 diuretics (P<0.0001).
Nebivolol did not impair glucose tolerance, either alone or in combination.
There was a negative correlation between Δpotassium and Δ2–hour glucose (r=–0.28; P<0.0001).
In 2 crossover studies, 4 weeks of treatment with a thiazide diuretic impaired glucose tolerance.
MDLinx connects healthcare professionals and patients to tomorrow's important medical news, while providing the pharmaceutical and healthcare industries with highly targeted interactive marketing, education, content, and medical research solutions.