Hydrochlorothiazide hypertension treatment induced metabolic effects in type 2 diabetes: a meta-analysis of parallel-design RCTs

J.-J. Lin, H.-C. Chang, C.-T. Ku, H.-Y. Chen

Department of Pharmacy, Feng-Yuan Hospital, Ministry of Health Welfare, Taichung, Taiwan, R.O.C. ctku@ttpc.mohw.gov.tw

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• Pharmacology

OBJECTIVE: Thiazide diuretics are still widely used as an initial therapy in essential hypertension, sometimes in both hypertensive and diabetic patients. However, the metabolic effects in type 2 diabetes treated with a thiazide diuretic have not been fully elucidated.

MATERIALS AND METHODS: Randomized controlled trials (RCTs) were identified from the electronic databases: the Cochrane Library, MEDLINE, and PubMed web of knowledge. The trials compared the metabolic effects of hydrochlorothiazide (HCTZ) versus no- HCTZ hypertension treatment in type 2 diabetes.

RESULTS: A total of 368 papers showed a match, in the keyword search. Upon screening the title, reading the abstract and the entire article, 13 parallel-design RCTs, described in 7 reports, involving 720 patients, showed fasting glucose (FG) (SMD = 0.27, 95% CI 0.11-0.43) and HbA1c (SMD = 1.09, 95% CI 0.47-1.72)significantly increased in the patients treated with HCTZ groups and high-density lipoprotein-cholesterol (HDL-C) (SMD = -0.44, 95% CI -0.81- -0.08) decreased in the patients treated with low-dose HCTZ groups. Our study showed FG, HbA1c and HDL-C significantly affected in the patients treated with low-dose HCTZ groups.

CONCLUSIONS: Our study showed FG and HbA1c increased in the patients treated with the low-dose HCTZ groups, and HDL-C decreased in the patients. While thiazide diuretics are still a recommended medication of hypertension therapy for type 2 diabetes, treatment with low-dose HCTZ should be attempted to evaluate the effectiveness and adverse metabolic effects.

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