Diuretic Regimen More Effectively Reduces CV Morbidity vs Telmisartan Combinations in Hypertension With Diabetes

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Previous studies on the suitability of diuretics for patients with hypertension and diabetes reveal inconsistencies.

The following article is part of conference coverage from the 2018 AHA Scientific Sessions in Chicago, Illinois.The Cardiology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in cardiology. Check back for the latest news from AHA 2018.

CHICAGO — A diuretic-based regimen reduces cardiovascular morbidity and mortality more effectively than a telmisartan-based combination among people with hypertension and diabetes, according to a study presented at the 2018 AHA Scientific Sessions, November 10-12, 2018, in Chicago, Illinois.

Researchers conducted an open-label, blinded-end point trial wherein patients with hypertension and diabetes were randomly assigned to receive either amlodipine plus telmisartan (N=1580) or amlodipine plus co-amilozide (N=1539).

The patients had participated in the Chinese Hypertension Intervention Efficacy Study conducted in 180 clinical centers in China.

At baseline, the telmisartan group and the diuretic-based group had a mean blood pressure of 26.4 mm Hg and 21.6 mm Hg, respectively. After 41 months, the primary outcome reported was the composite of nonfatal stroke, nonfatal myocardial infarction, or death from cardiovascular causes.

Both groups experienced a similar blood pressure reduction. At the end of the trial, mean blood pressure in the telmisartan group was 14.2 mm Hg and in the diuretic therapy-based group, mean blood pressure was 14.0 mm Hg.

Study data revealed, however, that more primary end point events occurred in the telmisartan-based group (n=58) than in the diuretic-based group (n=93), representing a relative risk reduction of 36.4% (hazard ratio [HR], 0.64; 95% CI, 0.46-0.88; P =.007).

Further, researchers noted that the diuretic-based group showed a trend toward a reduction in all stroke (HR, 0.70; P =.08) and all-myocardial infarction (HR, 0.54; P =.10).

“Our findings suggested that diuretics could be suitable medications for patients with hypertension and diabetes and that lowering blood pressure could reverse the long-term negative impacts of diabetes induced by diuretics on cardiovascular events.”

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Zhang Y, Lu P, Yang K, et. Al. Preferable benefits of diuretic-based combination to telmisartan-based combination in hypertensive patients with diabetes. Presented at: American Heart Association Scientific Sessions 2018; November 10-12, 2018; Chicago, IL.