For Immediate Release Contact: Tom Capezzuto
At UMDNJ-Robert Wood Johnson Medical School
UMDNJ Researchers Find that Long-Term Use of Diuretics Results in Improved Mortality Rates in Elderly, Especially Those with Diabetes--Study Published in January Issue of American Journal of Cardiology
1/3/05—Researchers at the University of Medicine and Dentistry of New Jersey (UMDNJ) have found that treating older hypertensive patients with diuretics decreases the rate of fatal heart attacks and strokes, even in those who developed diabetes while taking the diuretics.
In a published study, researchers from the UMDNJ-Robert Wood Johnson Medical School in New Brunswick and the University of Texas School of Public Health at Houston tracked 4,732 patients with hypertension for almost 15 years after they began treatment with the drug chlorthalidone or a placebo. They found a decrease in the number of cardiac-related deaths, particularly in those with diabetes.
The study, known as the Systolic Hypertension in the Elderly Program (SHEP), is published in the January issue of the American Journal of Cardiology.
“The results of this study disprove the long-term theory that diuretics will cause adverse long-term outcomes because they may trigger diabetes,” said Dr. John B. Kostis, chair of the Department of Medicine at the UMDNJ-Robert Wood Johnson Medical School and principal investigator of the study. Diabetes and hypertension are independently associated with a greater than two-fold increase in the risk of cardiovascular disease and their combination significantly increases that risk.
Diuretics have been associated in the development of diabetes and with good outcomes in shorter studies. However, physicians have speculated that in long-term treatment the diuretic-induced diabetes will worsen the outcomes. There are no other reports with long-term follow-up of controlled studies using diuretics, Dr. Kostis said.
“In our study, we found that the mortality rate was significantly lower--by 19 percent--in the chlorthalidone group than in the placebo group,” Dr. Kostis noted.
In the randomized study, patients were given daily doses ranging between 12.5 and 25 milligrams of chlorthalidone, or matching placebo, Dr. Kostis said. Thirty-two percent of the subjects whose blood pressure remained above target level with the diuretic, were given atenolol or reserpine with chlorthalidone to help control the blood pressure.
“We found that cardiovascular mortality rates did not significantly increase in individuals who received diuretics and developed compared to those treated with a placebo,” he noted. “Patients who developed diabetes during diuretic therapy had better outcomes than those who developed diabetes while on placebo.”
The SHEP study was supported by the National Heart and Lung and Blood Institute and National Institutes of Health.
The UMDNJ-Robert Wood Johnson Medical School is one of three medical schools of the University of Medicine and Dentistry of New Jersey. UMDNJ comprises New Jersey’s only medical schools, the state’s only dental school, a nursing school, a graduate school of biomedical sciences, a school of health related professions and a school of public health on campuses in Piscataway/New Brunswick, Newark, Camden, Stratford and Scotch Plains. It is affiliated with more than 200 health care and educational institutions throughout the state.
--January 3, 2005