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EDITORIAL Great Benefits, Special Risks HE BEST APPROACH for the treatment of hy- ing normal serum potassium levels, it is often difficult to pertension in diabetic patients is a subject keep potassium levels in the normal range, even with ag- gressive replacement. of much debate. However, data from a va- Another critical issue not addressed in the present investigation is magnesium depletion, more riety of studies, including the Hypertension T difficult to measure than potassium depletion but well known Optimal Treatment (HOT) study, Syst-Eur to occur with thiazide diuretics. Glucosuria, common in trial, and the Symbolic Hypertension in the Elderly Pro- patients with diabetes, causes magnesium depletion, which gram (SHEP), show that the treatment of hypertension in also contributes to insulin resistance, vasoconstriction, and diabetic patients lowers cardiovascular mortality and events thrombosis. Finally, there have been reports of diuretic to a greater extent than in the nondiabetic population. More- therapy increasing the risk of death in patients with diabe- over, results from the UK Prospective Diabetes Study tes, which may be more significant at doses above 25 mg/d (UKPDS) trial showed a 37% reduction in microvascular of hydrochlorothiazide. end points, with differences in systolic and diastolic blood pressure of
JAMA Internal Medicine – American Medical Association
Published: Mar 22, 1999
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