Diuretic

When a patient has high blood pressure, the first drug most doctors prescribe is a diuretic. By accelerating the loss of water and sodium from the body, these medications help lower blood pressure and thus decrease the risk of stroke, congestive heart failure and kidney failure. But a Swedish study released last week provides new evidence that so-called water pills may increase the danger of diabetes and heart attacks.

Reporting in the New England Journal of Medicine, researchers found that when hypertensive patients were given the popular diuretic hydrochlorothiazide, their ability to metabolize the sugar glucose dropped 11% and their blood levels of cholesterol and fats rose 5% and 15%, respectively. The researchers stress, however, that there is no proof to date that diuretics have raised the actual incidence of diabetes or heart attacks.

Nonetheless, the new findings have intensified debate about whether diuretics should remain a first-line option for treating high blood pressure. Many doctors support continued widespread use, arguing that newer, alternative drugs are more expensive and that their long-term side effects have not been as well established. But others are pressing for more restricted use of water pills. At the least, say some, patients who have diabetes probably should not be taking diuretics.