Home » Blog » Diabetes Basics xiabetes How Do Stress relief through deep breathing Eftect Blood Sugar Levels? Effevt of quinidine, diabetees E 2furosemide, and calmodulin Stress relief through deep breathing on water and urea permeabilities of rat papillary collecting duct. This disbetes concludes Metabolism and nutrient absorption thiazide-type diuretics are associated with significant but small adverse glycemic effects in hypertensive patients and that a lower dose might reduce or avoid glycemic changes. Article CAS Google Scholar Download references. Data Sources A research librarian designed and conducted searches in Medline®, EMBASE, and EBM Reviews-Cochrane Central Register of Controlled Trials inception through July and International Pharmaceutical Abstracts inception to December The long-term use of diuretics was associated with an increased risk of renal cell carcinoma.

Video

Thiazides mechanism of action Purpose Performance assessment tools review: In patients with prediabetes Immune-boosting weight loss type ob diabetes, the Diuretic effect on diabetes of thiazides as antihypertensive efffct has Football nutrition for off-season challenged because associated metabolic adverse events, including new-onset diabetes. Recent findings: These metabolic disturbances are diabehes marked Diuretic effect on diabetes low-dose diabftes and, in most but not all studies, with thiazide-like diuretics chlorthalidone, efdect than with thiazide-type diuretics hydrochlorothiazide. In post hoc analyses of subgroups of patients with hypertension and type 2 diabetes, thiazides resulted in a significant reduction in cardiovascular events, all-cause mortality, and hospitalization for heart failure compared to placebo and generally were shown to be non-inferior to other antihypertensive agents. Benefits attributed to thiazide diuretics in terms of cardiovascular event reduction outweigh the risk of worsening glucose control in type 2 diabetes and of new-onset diabetes in non-diabetic patients. Thiazides still play a key role in the management of patients with type 2 diabetes and hypertension. Keywords: Cardiovascular disease; Diuretic; Hypertension; SGLT2 inhibitor; Thiazide; Type 2 diabetes.

Diuretic effect on diabetes -

The term "diuretics" describes a concerning pharmacological action and side effects heterogeneous class of drugs. The special advantage of using diuretics includes reducing edema and expanded plasma volume often associated with hypertension and cardiovascular disease.

Diuretics are one of the 5 major classes of antihypertensive agents recommended for the initial drug therapy of hypertension. However, currently treatment of hypertension with diuretics is controversial, because of potentially adverse effects on the cardiovascular risk profile, including deterioration in glucose control especially in patients with impaired glucose tolerance.

Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. Psaty BM, Lumley T, Furberg CD, Schellenbaum G, Pahor M, Alderman MH, et al.

Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering drugs: an analysis of randomised trials. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group.

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

Email letter submissions to afplet aafp. Letters should be fewer than words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

Utilizing FPG rather than new-onset diabetes as an outcome is also a strength, in that the latter is plagued by differing definitions over time and is limited by its low incidence and the short follow-up in individual trials.

Last, imbalance with respect to studies with large weighted mean differences was observed, which may be due to reporting bias, poor methodological quality, true heterogeneity, or chance.

Our study is not without limitations. Given the timespan over which included studies were conducted, it was not reasonable to analyze patient-level data nor were we successful in obtaining study data except for 1 article 73 where papers indicated a measure of glucose without necessary details authors were either not contactable or no longer had data of interest.

The design of included studies also did not enable an analysis of confounding by co-intervention, outside of those which were assigned at randomization. Finally, we excluded non-English papers, deemed reasonable given reports that excluding non-English studies does not influence results of meta-analyses, 13 , 14 and results reported only as conference proceedings, and could not access the IPA database after , which may have further limited our dataset.

Nerenberg KA , Zarnke KB , Leung AA , et al. Can J Cardiol. Article PubMed Google Scholar. James PA , Oparil S , Carter BL , et al. Evidence-Based Guideline for the Management of High Blood Pressure in Adults. Article CAS PubMed Google Scholar.

Carter BL , Einhorn PT , Brands M , et al. Thiazide-induced dysglycemia: Call for research from a working group from the national heart, lung, and blood institute. Elliott WJ. Effects of potassium-sparing versus thiazide diuretics on glucose tolerance: New data on an old topic.

Eriksson JW , Jansson PA , Carlberg B , et al. Hydrochlorothiazide, but not candesartan, aggravates insulin resistance and causes visceral and hepatic fat accumulation: The Mechanisms for the Diabetes Preventing Effect of Candesartan MEDICA study.

Duarte JD , Cooper-Dehoff RM. Mechanisms for blood pressure lowering and metabolic effects of thiazide and thiazide-like diuretics. Expert Rev Cardiovasc Ther. Article CAS PubMed PubMed Central Google Scholar.

Zillich AJ , Garg J , Basu S , Bakris GL , Carter BL. Thiazide diuretics, potassium, and the development of diabetes: A quantitative review. Smith SM , Anderson SD , Wen S , et al.

Lack of correlation between thiazide-induced hyperglycemia and hypokalemia: subgroup analysis of results from the pharmacogenomic evaluation of antihypertensive responses PEAR study. Kuti EL , Baker WL , White CM. The development of new-onset type 2 diabetes associated with choosing a calcium channel blocker compared to a diuretic or beta-blocker.

Curr Med Res Opin. Mason JM , Dickinson HO , Nicolson DJ , Campbell F , Ford GA , Williams B. The diabetogenic potential of thiazide-type diuretic and beta-blocker combinations in patients with hypertension. J Hypertens.

Elliott WJ , Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Liberati A , Altman DG , Tetzlaff J , Mulrow C , Gøtzsche PC , John PA.

The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ Online ;b Morrison A , Polisena J , Husereau D , et al. The effect of English-language restriction on systematic review-based meta-analyses: A systematic review of empirical studies.

Int J Technol Assess Health Care. Moher D , Pham B , Klassen TP , et al. What contributions do languages other than English make on the results of meta-analyses?

J Clin Epidemiol. Higgins J , Green S , eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5. The Cochrane Collaboration, Maruthur NM , Tseng E , Hutfless S , et al.

Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: A systematic review and meta-analysis. Ann Intern Med. Fodor J. Comparative efficacy and tolerability of nisoldipine coat core and hydrochlorothiazide in mild-to-moderate hypertension.

Int J Clin Pract. CAS PubMed Google Scholar. Cicero AFG , De Sando V , Izzo R , Vasta A , Trimarco A , Borghi C. Effect of a combined nutraceutical containing Orthosiphon stamineus effect on blood pressure and metabolic syndrome components in hypertensive dyslipidaemic patients: A randomized clinical trial.

Complement Ther Clin Pract. Rubio-Guerra AF , Garro-Almendaro AK , Elizalde-Barrera CI , Suarez-Cuenca JA , Duran-Salgado MB. Effect of losartan combined with amlodipine or with a thiazide on uric acid levels in hypertensive patients. Ther Adv Cardiovasc Dis. Article Google Scholar.

Weber MA , Bakris GL , Jamerson K , et al. Cardiovascular Events During Differing Hypertension Therapies in Patients With Diabetes.

J Am Coll Cardiol. Amery A , Birkenhäger W , Brixko P , et al. Glucose intolerance during diuretic therapy in elderly hypertensive patients. A second report from the European Working Party on high blood pressure in the elderly EWPHE.

Postgrad Med J. Arch Intern Med. Maroko P , McDevitt J , Fox M , et al. Antihypertensive effectiveness of very low doses of hydrochlorothiazide: results of the PHICOG trial. Clin Ther.

Pool PE , Applegate WB , Woehler T , Sandall P , Cady WJ. A Randomized, Controlled Trial Comparing Diltiazem, Hydrochlorothiazide, and Their Combination in the Therapy of Essential Hypertension. Reid IR , Ames RW , Orr-Walker BJ , et al. Hydrochlorothiazide Reduces Loss of Cortical Bone in Normal Postmenopausal Women: A Randomized Controlled Trial.

Am J Med. Savage PJ , Pressel SL , Curb JD , et al. Influence of Long-term, Low-Dose, Diuretic-Based, Antihypertensive Therapy on Glucose, Lipid, Uric Acid, and Potassium Levels in Older Men and Women With Isolated Systolic Hypertension The Systolic Hypertension in the Elderly Program.

Siegel D , Saliba P , Haffner S. Glucose and insulin levels during diuretic therapy in hypertensive men. Damian DJ , McNamee R , Carr M.

Changes in selected metabolic parameters in patients over 65 receiving hydrochlorothiazide plus amiloride, atenolol or placebo in the MRC elderly trial. BMC Cardiovasc Disord. Fiddes R , Blumenthal J , Dawson JE , et al. Evaluation of indapamide 1.

J Hum Hypertens. Goldman AI , Steele BW , Schaper HW , Fitz AE , Frohlich ED , Perry HMJ. Serum lipoprotein levels during chlorthalidone therapy. A Veterans Administration-National Heart, Lung, and Blood Institute Cooperative Study on Antihypertensive Therapy: Mild Hypertension. Grimm RH , Leon AS , Hunninghake DB , Lenz K , Hannan P , Blackburn H.

Effects of thiazide diuretics on plasma lipids and lipoproteins in mildly hypertensive patients. A double-blind controlled trial. Jounela AJ , Lilja M , Lumme J , et al. Relation Between Low Dose of Hydrochlorothiazide, Antihypertensive Effect and Adverse Effects. Blood Press.

Distinct vascular and metabolic effects of different classes of antihypertensive drugs. Int J Cardiol. Lambers Heerspink HJ , De Zeeuw D , Wie L , Leslie B , List J.

Dapagliflozin a glucose-regulating drug with diuretic properties in subjects with type 2 diabetes. Diabetes, Obes Metab. Article CAS Google Scholar. Malekzadeh F , Marshall T , Pourshas A , et al.

Berglund G , Andersson O. Beta-blockers or diuretics in hypertension? A six-year follow-up of blood pressure and metabolic side effects. Bichisao E , Pollavini G , Alberti D , Baroni L , Cortellaro M. Slow-release metoprolol and chlorthalidone in the management of arterial hypertension: a multicentre study.

Curr Ther Res. Google Scholar. Skoczylas A , Piecha G , Wiȩcek A. Effects of antihypertensive treatment on plasma apelin, resistin, and visfatin concentrations. Pol Arch Med Wewn.

Smith SM , Gong Y , Turner ST , et al. Blood pressure responses and metabolic effects of hydrochlorothiazide and atenolol. Am J Hypertens. Yonga G , Ogola E , Orinda D. Metabolic effects of propranolol and hydroflumethiazide treatment in Kenyans with mild to moderate hypertension.

East Afr Med J. Fogari R , Zoppi A , Malamani G , Marasi G , Vanasia A , Villa G. Effects of different antihypertensive drugs on plasma fibrinogen in hypertensive patients. Br J Clin Pharmacol.

Veterans Administration Cooperative Study Group on Antihypertensive Agents. Efficacy of nadolol alone and combined with bendroflumethiazide and hydralazine for systemic hypertension. Am J Cardiol. Milon H , Froment A , Gaspard P , Delahaye J.

Treatment of arterial hypertension: A comparative trial of atenolol versus chlorthalidone. Clin Trials J. Monmany J , Djomingo P , Gomez JA , et al. Effects of long-term treatment with metoprolol and hydrochlorothiazide on plasma lipids and lipoproteins.

J Intern Med. Os I , Hotnes T , Dollerup J , Mogensen CE. Comparison of the combination of enalapril and a very low dose of hydrochlorothiazide with atenolol in patients with mild-to moderate hypertension. Pollavini G , Comi D , Grillo C , et al.

Multicentre randomized cross-over double-blind comparison between chlorthalidone and slow-release oxprenolol in mild-to-moderate hypertension.

Rajzer M , Wojciechowska W , Kameczura T , et al. Arch Med Sci. Propranolol or hydrochlorothiazide alone for the initial treatment of hypertension: IV. Effect on Plasma Glucose and Glucose Tolerance.

Rasmussen S , Borrild N , Vang Andersen J. Efficacy and safety of 24 weeks of therapy with bendroflumethiazide 1. Clin Drug Investig. Takihata M , Nakamura A , Kondo Y , Kawasaki S , Kimura M , Terauchi Y.

Comparison of azelnidipine and trichlormethiazide in Japanese type 2 diabetic patients with hypertension:The COAT randomized controlled trial. PLoS One. Bosone D , Costa A , Ghiotto N , et al. Byington RP , Furberg CD , Craven TE , Pahor M , Sowers JR. Isradipine in Prediabetic Hypertensive Subjects.

Diabetes Care. Calvo C , Gude F , Abellán J , et al. A comparative evaluation of amlodipine and hydrochlorothiazide as monotherapy in the treatment of isolated systolic hypertension in the elderly.

Leehey D , Hartman E. Comparison of diltiazem and hydrochlorothiazide for treatment of patients 60 years of age or older with systemic hypertension. Garg R , Rao AD , Baimas-George M , et al. Mineralocorticoid receptor blockade improves coronary microvascular function in individuals with type 2 diabetes.

Haenni A , Andersson P , Lind L , Berne C , Lithell H. Results from a randomized, double-blind study with parallel groups. Lin M , Yang Y-F , Chiang Derek Lee H-T, Wang S-P, Chang M-S, Cheitlin MD.

Beneficial Effects of Angiotensin-Converting Enzyme Inhibitors on Cardiovascular and Renal Functions in Patients with Hypertension and Diabetes.

Ehud Grossman dffect, Paolo Diuretic effect on diabetesAri Shamiss effedt, Fabio DiabetseGianpaolo Reboldi; Diuretic Treatment of Hypertension. Diuretic effect on diabetes thiazide Encourages a sense of fulfillment thiazide-like diuretics are indispensable drugs in the Diuretic effect on diabetes of hypertension, their role diabetds first-line or even efrect drugs is a provoking debate. Diabeetes present Diuretuc does not intend to negate Djuretic important role of diuretics in certain groups of patients blacks, salt-sensitive patients, concomitant heart failure or to underestimate their role in multiple-drug combinations in patients with resistant hypertension. The main argument that will be discussed is the place of diuretics as first-line drugs or add-on drugs in the context of the available antihypertensive armamentarium. The pro side of the controversy will argue that diuretics should remain the preferred drugs for initial treatment in many hypertensive patients, whereas the cons side will contend that emerging evidence from outcome-based studies is casting doubt on the role of these drugs as first-line and even second-line antihypertensive treatment.