UMDNJ Researchers Find that Long-Term Use of Diuretics Results in Improved Mortality Rates in Elderly
Tuesday, January 04, 2005
Researchers at the University of Medicine and Dentistry of New Jersey (UMDNJ) have found that treating older hypertensive patients with diuretics decreases the rate of fatal heart attacks and strokes, even in those who developed diabetes while taking the diuretics.
In a published study, researchers from the UMDNJ-Robert Wood Johnson Medical School in New Brunswick and the University of Texas School of Public Health at Houston tracked 4,732 patients with hypertension for almost 15 years after they began treatment with the drug chlorthalidone or a placebo. They found a decrease in the number of cardiac-related deaths, particularly in those with diabetes.
The study, known as the Systolic Hypertension in the Elderly Program (SHEP), is published in the January issue of the American Journal of Cardiology.
“The results of this study disprove the long-term theory that diuretics will cause adverse long-term outcomes because they may trigger diabetes,” said Dr. John B. Kostis, chair of the Department of Medicine at the UMDNJ-Robert Wood Johnson Medical School and principal investigator of the study. Dr. Kostis is also chief of Medical Service at Robert Wood Johnson University Hospital.
Diabetes and hypertension are independently associated with a greater than two-fold increase in the risk of cardiovascular disease and their combination significantly increases that risk.
Diuretics have been associated in the development of diabetes and with good outcomes in shorter studies. However, physicians have speculated that in long-term treatment the diuretic-induced diabetes will worsen the outcomes. There are no other reports with long-term follow-up of controlled studies using diuretics, Dr. Kostis said.
“In our study, we found that the mortality rate was significantly lower--by 19 percent--in the chlorthalidone group than in the placebo group,” Dr. Kostis noted.
In the randomized study, patients were given daily doses ranging between 12.5 and 25 milligrams of chlorthalidone, or matching placebo, Dr. Kostis said. Thirty-two percent of the subjects whose blood pressure remained above target level with the diuretic, were given atenolol or reserpine with chlorthalidone to help control the blood pressure.
“We found that cardiovascular mortality rates did not significantly increase in individuals who received diuretics and developed compared to those treated with a placebo,” he noted. “Patients who developed diabetes during diuretic therapy had better outcomes than those who developed diabetes while on placebo.”
The SHEP study was supported by the National Heart and Lung and Blood Institute and National Institutes of Health.
The UMDNJ-Robert Wood Johnson Medical School is one of three medical schools of the University of Medicine and Dentistry of New Jersey. UMDNJ comprises New Jersey’s only medical schools, the state’s only dental school, a nursing school, a graduate school of biomedical sciences, a school of health related professions and a school of public health on campuses in Piscataway/New Brunswick, Newark, Camden, Stratford and Scotch Plains. It is affiliated with more than 200 health care and educational institutions throughout the state.
About Robert Wood Johnson University Hospital
Selected as one of four hospitals nationwide to offer the world's first self-contained implantable artificial heart, Robert Wood Johnson University Hospital (www.rwjuh.edu) is a 600-bed academic medical center and the principal hospital of UMDNJ-Robert Wood Johnson Medical School in New Brunswick, NJ. Robert Wood Johnson is an innovative leader in advancing state-of-the-art care in medicine. Its Centers of Excellence include cardiovascular care from minimally invasive heart surgery to transplantation, cancer care, and women's and children's care including The Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital (www.bmsch.org). The hospital is also a Level 1 Trauma Center and serves as a national resource in its ground-breaking approaches to emergency preparedness.
The hospital has earned significant national recognition for clinical quality and patient safety. Robert Wood Johnson University Hospital is ranked among the top 50 hospitals in the nation for both heart and heart surgery and respiratory disorders, according to U.S.News & World Report's 2008 ranking of "America's Best Hospitals." The American College of Surgeons' Commission on Cancer has rated Robert Wood Johnson University Hospital among the nation's best comprehensive cancer centers. The Leapfrog Group rated Robert Wood Johnson University Hospital as one of the 50 exceptional U.S. hospitals, as published in Consumers Digest magazine. Harvard University researchers, in a study commissioned by The Commonwealth Fund, identified Robert Wood Johnson University Hospital as one of the top 10 hospitals in the nation for clinical quality. Robert Wood Johnson University Hospital is also a recipient of the prestigious Magnet Award for Nursing Excellence for more than 10 consecutive years.
Attention members of the media: For more information on this release, please contact the Department of Public Relations (732) 937-8521.
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