E-drug: Re: 1999 WHO-ISH hypertension guidelines
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I congratulate J�r�me Sclafer and La revue Prescrire for their summary of
how to delay the complications of hypertension. However I am uncertain re
one point. What is best for diabetics?
J�r�me et al recommend Beta-Blockers and ACE Inhibitors but not Thiazides.
Beta-Blockers and ACE Inhibitors appeared to be equal for type 2 diabetes
in UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril
in reducing risk of macrovascular and microvascular complications in type 2
diabetes: UKPDS 39. BMJ 1998;317:713-720.
However as far as I know neither have been compared to placebo so they both
could be equally ineffective!
By contrast "thiazides" have been found superior to placebo in the SHEP
trial: Curb JD et al. Effect of diuretic-based antihypertensive treatment
on cardiovascular disease risk in older diabetic patients with isolated
systolic hypertension. JAMA 1996; 276: 1886-92. (SHEP used chlorthalidone
which is a "thiazide like drug" ie it does not have a thiazide ring but its
action appears to be the same.)
Perhaps thiazides should be the first line drug of choice for hypertensives
with NIDDM as they are the only drugs shown to significantly reduce CVD
morbidity and mortality?
Regarding type 1 diabetes as far as I can work out no one knows.
If anyone can help with this please let us know.
If you are interested in the trial results for Ca channel blockers and have
www access and Acrobat reader then you may enjoy "Healthy Scepticism about
CCBs February 1999" which was written by MaLAM for the GPs of New Zealand:
www.camtech.net.au/malam/NZ/healthy.htm
If you are interested but lack access then ask me for either the text as a
Word 97 document or the text as a plain e-mail message.
regards,
Peter
Dr Peter Mansfield
Director, MaLAM
MaLAM encourages pharmaceutical companies to provide more reliable
information to assist appropriate health care.
MaLAM Headquarters
PO Box 172, Daw Pk SA 5041, Australia
phone/fax +61 8 8374 2245
peter.mansfield@flinders.edu.au
http://www.camtech.net.au/malam
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