RSS Feeds
Prazosin, Diuretics, and Glucose Intolerance
- Herbert Ross, MD; and
- Marvin Moser, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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.
Although hypertension may be characterized by an increase in insulin resistance [4] and may be associated with an increased risk for developing glucose intolerance or diabetes, a recent review suggests that the risk is not increased to any greater extent by diuretics when compared with any other hypertensive agents [5].
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
