(Message in Diabetes)

#: 704728 S8/Complications  (CIS:DIABETES)
    05-Mar-97  16:11:18
Sb: Diuretics/Beta-Blockers
Fm: Bruce Beale-SYSOP 100345,3667
To: all
Replies: 0    TID: 100104    Par: 0         Chd: 0         Sib: 0

Diuretics/Beta-Blockers Still First-Line Antihypertensive Agents

 Low-dose diuretics and beta-blockers remain first-line antihypertensive 
agents. The reminder comes from Seattle, Washington, investigator Dr. Bruce 
M. Psaty, who conducted a "...systematic review and meta-analysis..." of 
available scientific evidence on the safety and efficacy of various 
antihypertensive therapies.



 Dr. Psaty notes, in a paper in JAMA today, that, while some experts favor the 
newer antihypertensive agents such as calcium channel blockers and ACE 
inhibitors as first-line therapy, he believes the jury is still out. "Until the 
results of large long-term clinical trials evaluating the effects of calcium 
channel blockers and ACE inhibitors on cardiovascular disease incidence 
are completed, the available scientific evidence provides strong support for 
the current national guidelines, which recommend [low-dose] diuretics and 
[beta]-blockers as first-line [antihypertensive] agents."



 Dr. Psaty comments in a University of Washington press release that 
"...[w]hen measured in terms of health outcomes that are important to 
patients, there are few special indications for the newer agents to be used as 
first-line antihypertensive therapy. ACE inhibitors, for instance, are known to 
be effective in patients with congestive heart failure and in insulin-dependent 
diabetes patients with renal disease. For other 'special indications,' the 
potential benefits must be weighed against the known health risks of 
withholding proven first-line therapies currently recommended [by national 
guidelines]."



 JAMA 1997;277:739-745.