Influence of Long-term, Low-Dose, Diuretic-Based, Antihypertensive Therapy on Glucose, Lipid, Uric Acid, and Potassium Levels in Older Men and Women With Isolated Systolic Hypertension<subtitle>The Systolic Hypertension in the Elderly Program</subtitle>
Abstract
Background Previous studies often of short duration have raised concerns that antihypertensive therapy with diuretics and beta-blockers adversely alters levels of other cardiovascular disease risk factors. Methods The Systolic Hypertension in the Elderly Program was a community-based, multicenter, randomized, double-blind, placebo-controlled clinical trial of treatment of isolated systolic hypertension in men and women aged 60 years and older. This retrospective analysis evaluated development of diabetes mellitus in all 4736 participants in the Systolic Hypertension in the Elderly Program, including changes in serum chemistry test results in a subgroup for 3 years. Patients were randomized to receive placebo or treatment with active drugs, with the dose increased in stepwise fashion if blood pressure control goals were not attained: step 1, 12.5 mg of chlorthalidone or 25.0 mg of chlorthalidone; and step 2, the addition of 25 mg of atenolol or 50 mg of atenolol or reserpine or matching placebo. Results After 3 years, the active treatment group had a 13/4 mm Hg greater reduction in systolic and diastolic blood pressure than the placebo group (both groups, P Conclusions Antihypertensive therapy with low-dose chlorthalidone (supplemented if necessary) for isolated systolic hypertension lowers blood pressure and its cardiovascular disease complications and has relatively mild effects on other cardiovascular disease risk factor levels.
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Diuretics can precipitate acute kidney injury and electrolyte abnormalities, and the hypokalemic response to diuretics is diminished with low eGFR and depends on the type of diuretic used.
“Diuretics can precipitate acute kidney injury (AKI) and electrolyte abnormalities, and the hypokalemic response to diuretics is diminished with low eGFR and depends on the type of diuretic used.”
From KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease (2022) · cites this paper as [80]
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de Boer, I. H., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Khunti, K., Liew, A., Michos, E. D., Navaneethan, S. D., Olowu, W. A., et al. (2020) · Kidney International · doi:10.1016/j.kint.2020.06.019 · Cited by 1,399 · see citing works
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Evidence-based Diuretics: Focus On Chlorthalidone and Indapamide
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- Authors
- Savage, P. J.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Savage, Peter J.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1998-04-13
- Volume
- 158
- Issue
- 7
- Pages
- 741
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2133497763
- Cited by
- 292
- References
- 4
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 3 · 2023: 5 · 2022: 7 · 2021: 7 · 2020: 5 · 2019: 17 · 2018: 8 · 2017: 7 · 2016: 7 · 2015: 15 · 2014: 9 · 2013: 9 · 2012: 7
- FWCI
- 9.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- isolated systolic hypertension, diuretic therapy, chlorthalidone, atenolol, reserpine, beta-blockers, diabetes mellitus, glucose, lipids, uric acid, potassium, blood pressure control, older adults, cardiovascular risk factors, Systolic Hypertension in the Elderly Program, triglycerides, HDL cholesterol, creatinine
- MeSH terms
- Aged, Antihypertensive Agents, Blood Glucose, Chlorthalidone, Diuretics, Double-Blind Method, Female, Humans, Hypertension, Lipids, Male, Potassium, Risk Factors, Systole, Time Factors, Uric Acid, Treatment Outcome
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