NPCi Blog: Diuretics are an appropriate first-line choice in patients with hypertensi

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This Blog provides a quick and succinct commentary on a recent subgroup analysis of patients with metabolic syndrome in the ALLHAT study, which found that the incidence of heart failure was higher in patients initially treated with amlodipine and lisinopril (and doxazosin) than in those initially treated with a diuretic. These findings were particularly apparent in black patients.

The Blog notes that the NICE guideline did not recommend diuretics as the first-line treatment for hypertension ahead of calcium channel blockers for those aged 55 years or black (of any age) because of the supposition that diuretics were associated with a higher incidence of developing of diabetes. However, the guideline did not specifically consider patients with metabolic syndrome or diabetes. It adds that there is no convincing evidence to support the view that use of diuretics in people with these conditions puts them at any greater cardiovascular risk than those treated with ACE inhibitors or calcium channel blockers. It concludes “this analysis adds weight to the positioning of thiazide diuretics as first-line antihypertensive in the vast majority of patients with hypertension. This study fails to support the use of calcium channel blockers, ACE inhibitors (or alpha-blockers) ahead of diuretics in patients with metabolic syndrome. Clinicians should consider their current practice in comparison with the recommendations made by NICE.”
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