Abstract
BackgroundThe use of diuretics for hypertension has been associated with unfavorable changes in cardiovascular risk factors, such as uric acid and glucose tolerance, though the findings in the literature are contradictory.MethodsThis study investigated whether diuretic use is associated with markers of metabolic and cardiovascular risk, such as insulin-resistance and uric acid, in a cohort of adults without known diabetes and/or atherosclerotic cardiovascular disease. Nine hundred sixty-nine randomly selected participants answered a questionnaire on clinical history and dietary habits. Laboratory blood measurements were obtained in 507 participants.ResultsPreviously undiagnosed type 2 diabetes was recognized in 4.2% of participants who were on diuretics (n = 71), and in 2% of those who were not (n = 890; P = 0.53). Pre-diabetes was diagnosed in 38% of patients who were on diuretics, and in 17.4% (P < 0.001) of those who were not. Multivariate analysis showed that insulin-resistance (HOMA-IR) was associated with the use of diuretics (P = 0.002) independent of other well-known predisposing factors, such as diet, physical activity, body mass index, and waist circumference. The use of diuretics was also independently associated with fasting plasma glucose concentrations (P = 0.001) and uric acid concentrations (P = 0.01).ConclusionsThe use of diuretics is associated with insulin-resistance and serum uric acid levels and may contribute to abnormal glucose tolerance.
Highlights
The use of diuretics for hypertension has been associated with unfavorable changes in cardiovascular risk factors, such as uric acid and glucose tolerance, though the findings in the literature are contradictory
Undiagnosed type 2 diabetes was identified in 3 (4.2%), pre-diabetes in 27 (42.2%) of participants with hypertension who were on diuretics (n = 71), and in 28.9% (6 type 2 diabetics and 49 pre-diabetics) of those with hypertension who were not (n = 190; P = 0.03)
Given the results of our multivariate analysis, we are inclined to exclude that the association of diuretic use with homeostasis model assessment of insulin resistance (HOMA-IR) and Fasting plasma glucose (FPG) is a consequence of the frequent association between diabetes and hypertension
Summary
The use of diuretics for hypertension has been associated with unfavorable changes in cardiovascular risk factors, such as uric acid and glucose tolerance, though the findings in the literature are contradictory. Treatment of hypertension with diuretics has often been attributed to increased insulin resistance and accelerated onset of diabetes [4,5,6,7]. It has been reported that hypertension often precedes the onset of diabetes, suggesting that anti-hypertensive treatment with diuretics may contribute to the development of abnormal glucose tolerance, offsetting the benefits of the treatment in terms of cardiovascular risk [8,9]. The impact of anti-hypertensive treatment with diuretics on insulin resistance and glycemia in people without known diabetes and/or atherosclerotic diseases is still a matter of debate [14,18,19,20,21]
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