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Abstract

National guidelines (ANAES 2000), JNC VI and WHO-ISH recommend that any triple antihypertensive therapy should include diuretics. The aim of this study was to compare retrospectively medical and paramedical treatment and control of blood pressure in hypertensive patients treated with or without diuretics.

Method: The study included 5 754 hypertensive patients treated with at least 3 anti-hypertensive agents, admitted in Long Duration Affection (LDA) for hypertension between May 31st, 1999 and November 15th, 1999 by one of the three main medical insurance organizations. Medical data were collected by the counselling physician with the help of the GP. Statistical analyses were performed using Chi Square and ANOVA.

Results: The “Diuretic” group was much larger (5041 patients: 87.6 %) than the “non-Diuretic” group (713 patients: 12.4 %). Women were treated more frequently with diuretics than men (89 % versus 86 %, p<0.001). Mean age was 64 and 62 years (p =0.003), respectively. Ninety three per cent (492 of 530) of the patients with heart failure were treated with diuretics. The other co-morbidities analyzed were comparable between the two groups (coronary heart disease, chronic renal failure, diabetes, arteritis, bronchopathy and asthma). The frequency of electrocardiogram, echocardiogram or eye examination during the year preceding the study is summarized in the following table:

GroupElectrocardiogramEchocardiogramEye examination
Diuretics3910 (78 %)2431 (49 %)1894 (39 %)
No Diuretics574 (81 %)358 (52 %)301 (44 %)
pNSNS0.016
GroupElectrocardiogramEchocardiogramEye examination
Diuretics3910 (78 %)2431 (49 %)1894 (39 %)
No Diuretics574 (81 %)358 (52 %)301 (44 %)
pNSNS0.016
GroupElectrocardiogramEchocardiogramEye examination
Diuretics3910 (78 %)2431 (49 %)1894 (39 %)
No Diuretics574 (81 %)358 (52 %)301 (44 %)
pNSNS0.016
GroupElectrocardiogramEchocardiogramEye examination
Diuretics3910 (78 %)2431 (49 %)1894 (39 %)
No Diuretics574 (81 %)358 (52 %)301 (44 %)
pNSNS0.016

Biological monitoring was comparable in both groups, except for proteinuria which was performed more often in patients without diuretics (p < 0.001). Biological results did not show any significant difference between the two groups. Blood pressure control, according to the guidelines (<=140/90 mm Hg), is obtained for 23,5 % of patients in the “diuretic” group and only 18,5 % of patients in the other group (p=0.003). Mean blood pressure was 154/87 mmHg and 156/88 mmHg (SBP/DBP: p=0.007 ;NS) respectively.

Conclusion: In this study, 12.4% of the hypertensive patients where not treated with diuretics despite published recommendations. Blood pressure control was obtained more often for patients treated with diuretics than without.

diuretics, tritherapy, high blood pressure
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© American Journal of Hypertension, Ltd. 2001
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