Abstract
This study explores the effect of diuretics use on metabolic markers (i.e., the lipid profile) since thiazide diuretics are extensively used to treat cardiac patients with hypertension (HTN) and other comorbidities.The Embase and PubMed databases were searched for relevant English-language peer-reviewed articles. Different search terms and medical subject headings (MesH) terms were used to find the relevant articles.Our study included randomized controlled trials with hypertensive adult patients in the intervention group receiving thiazide diuretics; controls receiving any other diuretic or any other intervention for HTN where an intention to treat analysis was performed.We collected the demographic details, baseline lipid profile values, and end-of-study lipid profile values of all the participants in the studies along with the standard deviation of each value to calculate the net change effect.Five studies were included. We used the Q-test and I2 index for heterogeneity and the inverse variance method for weighting. We used the fixed effects model for total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) because TC and LDL-C had no heterogeneity (I2 was 0%). We used a random-effects model for triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C), which showed moderate heterogeneity (I2 was 57.2% and 59.5%, respectively). We used the Cochrane quality assessment to assess the quality level of the included studies. We used a funnel plot to avoid publication bias.Diuretics have a significant effect on lipid profiles. However, because this conclusion is supported by a low number of studies, further research is needed, and physicians are advised to use their best clinical judgment until the relationship between diuretics and lipid profiles seen in this study can be further supported by additional studies.
Highlights
BackgroundHypertension (HTN) is a major cause of morbidity and mortality and an important public health challenge worldwide
Diuretics were classified as the first drug of choice to start treatment in both the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the World Health Organization (WHO)/International Society of Hypertension Guidelines [4]
The antihypertensive effect of thiazides may decrease the risk of acute myocardial infarction, but this is counteracted by increases in total and low-density lipoprotein cholesterol concentrations [14]
Summary
BackgroundHypertension (HTN) is a major cause of morbidity and mortality and an important public health challenge worldwide. Data from the National Health and Nutrition Examination Survey from 2011 to 2012 indicate the age-adjusted prevalence of HTN among adults in the United States aged 18 years and older was 29.1%. Among adults with HTN, 82.7% were aware of their HTN and 75.6% reported currently taking prescribed medication to lower their blood pressure. Among the oral medications to treat HTN, diuretics are considered one of the more effective options for the treatment of essential HTN, and their efficacy in reducing mortality in hypertensive patients has already been reported [2,3]. Diuretics were classified as the first drug of choice to start treatment in both the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the World Health Organization (WHO)/International Society of Hypertension Guidelines [4]
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