Efficacy of diuretics and beta-blockers in diabetic hypertensive patients - Results from a meta-analysis

OBJECTIVE - To review the effectiveness of diuretic or beta-blocker-based t reatment of hypertension in diabetic patients. RESEARCH DESIGN AND METHODS - A meta-analysis on individual patient data wa s performed on four trials of the treatment of hypertension in which diabet ic patients were included and treated with first-line diuretics or beta-blo ckers. The main outcomes were the relative risk of death, fatal or nonfatal stroke, fatal or nonfatal coronary events, and major cardiovascular events . RESULTS - There were 92 diabetic patients who received first-line beta-bloc kers and 1,008 who received diuretics. In the control groups, diabetic pati ents had nearly twice the risk of any outcome when compared with nondiabeti c patients. The same blood pressure reduction was achieved under treatment in the diabetic and nondiabetic patients, except for systolic pressure, whi ch decreased more in the nondiabetic patients at 1 year. In the 15,843 nond iabetic patients, the risk of all four outcomes was reduced significantly i n the treated group. In the 2,254 diabetic patients, the risk reduction was significant only for fatal and nonfatal stroke (36%, P = 0.011) and major cardiovascular events (20%, P = 0.032),but not for death (5%, P = 0.65) and fatal or nonfatal coronary events (15%, P = 0.23). However, no heterogenei ty was detected between diabetic patients and nondiabetic patients for any outcome. The numbers of outcomes avoided for 1,000 patients treated for 5 y ears were higher in diabetic patients (e.g., 38 major cardiovascular events ) than with nondiabetic patients (e.g., 28 major cardiovascular events). CONCLUSIONS - These results show that hypertensive diabetic patients benefi t from first-line treatment with diuretics. No conclusion can be drawn for beta-blockers, owing to the small sample size.