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LETTER
Prazosin, Diuretics, and Glucose Intolerance
Herbert Ross and
Marvin Moser
15 October 1993 | Volume 119 Issue 8 | Pages 859-860
TO THE EDITOR:
Pandit and colleagues [1] are to be commended for a concise, comprehensive overview of drug-induced disorders of glucose metabolism. Certain assertions on the effects of diuretics deserve comment, however, because of their wide use in the treatment of patients with hypertension.
The "failure to dramatically reduce" the risk for coronary artery disease in diuretic-based clinical trials may be more illusory than real. A recent meta-analysis of 17 treatment trials in middle-aged and elderly patients with hypertension [2] shows a 16% reduction in the risk for fatal and total coronary events (95% CI, 5% to 26% and 8% to 23%, respectively; P = 0.06 for fatal events and P = 0.0001 for total events). Earlier assertions of lack of benefit relied on data from individual trials of short duration and trials that were not originally designed to test the benefits of a modest reduction in blood pressure for coronary events.
Pandit and colleagues cite an early report of a 30% incidence of glucose intolerance in patients with hypertension who were treated with thiazides. However, the actual observed incidence of new-onset diabetes after administration of large doses of thiazide in the 3- to 5-year diuretic-based intervention trials was considerably lower [3] (Table 1). More recent thiazide-based studies have also confirmed an incidence of less than 1% to 2% in hyperglycemia or diabetes, as well as the fact that coronary mortality is reduced to the same extent in patients with and without diabetes.
1. Pandit MK, Barke J, Gustafson AB, Minocha A, Peiris AN. Drug-induced disorders of glucose tolerance. Ann Intern Med. 1993; 118: 529-39.
2. Hebert P, Moser M, Mayer J, Glynn RJ, Hennekins CH. Recent evidence on drug therapy of mild to moderate hypertension and decreased risk of coronary heart disease. Arch Intern Med. 1993; 153:578-81.
3. Moser M, Ross H. The treatment of hypertension in diabetic patients. Diabetes Care. 1993; 16:542-7.
4. Ferrannini E, Buzzigoli G, Bonadonna R, Giorico MA, Oleggini M, Graziadei L, et al. Insulin resistance in essential hypertension. N Engl J Med. 1987; 317:350-7.
5. Gurwitz JH, Bohn RL, Glynn RJ, Monane M, Mogun H, Avorn J. Antihypertensive drug therapy and the initiation of treatment for diabetes mellitus. Ann Intern Med. 1993; 118:273-8.
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