Excess mortality associated with diuretic therapy in diabetes mellitus.
Excess mortality associated with diuretic therapy in diabetes mellitus.
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DOI：
10.1001/archinte.151.7.1350
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发表时间：
1991
影响因子：
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通讯作者：
J. Warram;L. Laffel;P. Valsania;A. Christlieb;A. Krolewski
中科院分区：
文献类型：
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作者：
J. Warram;L. Laffel;P. Valsania;A. Christlieb;A. Krolewski
目的探讨接受高血压治疗的糖尿病患者的高死亡率是否可以由相关危险因素解释，还是必须归因于降压治疗的有害作用。队列分析研究，中位随访时间为4.5年。门诊糖尿病和严重视网膜病变患者参加了一项多中心、随机的激光治疗防盲临床试验，每4个月进行一次眼科检查，每年进行一次体检，包括测量血压和记录降压治疗情况。只有5.5%的患者无法随访。当患者死亡时，死亡率审查委员会对其死亡情况进行审查和分类。参与者——研究中有759名参与者；他们是白人，年龄在35到69岁之间，基线检查时血清肌酐水平正常。测量和主要结果：根据基线和首次年度随访检查记录的信息，将患者分为五组：血压正常（舒张压小于90毫米汞柱）、未治疗的高血压、单用利尿剂治疗的高血压、单用其他药物治疗的高血压、双药治疗的高血压。高血压治疗患者的心血管死亡率高于未治疗的高血压患者。过量的血压主要出现在单独使用利尿剂的患者身上，尽管这组患者在接受利尿剂治疗后血压最低。在校正了危险因素的差异后，单独使用利尿剂治疗的高血压患者的心血管死亡率是未治疗高血压患者的3.8倍（P < 0.001）。结论：在糖尿病患者中，利尿剂干预降低高血压与高死亡率相关。在有临床试验显示利尿剂治疗糖尿病患者的有益效果之前，迫切需要重新考虑利尿剂在该人群中的继续使用。
OBJECTIVE To determine whether the high mortality among diabetic patients receiving treatment for hypertension can be explained by associated risk factors or must be attributed to a deleterious effect of antihypertensive treatment. DESIGN Cohort analytic study with a median follow-up of 4.5 years. SETTING Outpatients with diabetes and severe retinopathy who were enrolled in a multicenter, randomized clinical trial of laser treatment to prevent blindness had ophthalmologic examinations every 4 months and annual medical examinations that included measurement of blood pressure and recording of anti-hypertensive treatment. Only 5.5% of the patients were unavailable for follow-up. When a patient died, the circumstances surrounding the death were reviewed and classified by a mortality review committee. PARTICIPANTS --There were 759 participants in the study; they were white, were aged 35 to 69 years, and had normal serum creatinine levels at the baseline examination. MEASUREMENTS AND MAIN RESULTS --Patients were classified into five groups according to information recorded at the baseline and first annual follow-up examinations: normotensive (diastolic blood pressure less than 90 mm Hg), untreated hypertensive, hypertensive treated by diuretics alone, hypertensive treated by other agents alone, and hypertensive treated by both agents. Cardiovascular mortality was higher in patients treated for hypertension than in patients with untreated hypertension. The excess was primarily found in patients treated with diuretics alone, although that group had the lowest blood pressure with treatment. After adjusting for differences in risk factors, cardiovascular mortality was 3.8 times higher in patients treated with diuretics alone than in patients with untreated hypertension (P less than .001). CONCLUSIONS --In individuals with diabetes, intervention with diuretics to reduce hypertension is associated with excess mortality. Until there is a clinical trial showing a beneficial effect of diuretic treatment in diabetic patients, there is urgent need to reconsider its continued usage in this population.