Thiazides linked to risk for stroke in patients with type 2 diabetes

  • Tsujimoto T & al.
  • Hypertension
  • 4 Nov 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • In patients with type 2 diabetes (T2D), specifically those receiving intensive blood pressure (BP), the risk for major adverse cardiovascular event (MACE) and particularly stroke was higher with the use of thiazides.

Why this matters

  • Findings suggest that thiazide use may increase the risk for stroke in T2D patients with relatively low BP.

Study design

  • This observational study included 10011 patients with T2D (patients taking thiazides, n=2769; not taking thiazides, n=7242) using data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
  • Primary outcome: MACE-composite of death, nonfatal myocardial infarction, and nonfatal stroke.
  • Funding: National Center for Global Health and Medicine and others.

Key results

  • Overall, mean follow-up period was 7.7 years, and 1776 patients experienced MACEs.
  • At baseline, mean systolic BP in patients taking and not taking thiazides was 137.2 and 135.7 mmHg, respectively.
  • The event rate for MACE was higher in patients taking thiazides than in those taking thiazides (24.2 vs 22.5 per 1000 person-years).
  • Risk for MACE and stroke was significantly higher in patients taking thiazides vs those not taking thiazides (aHR, 1.12; 95% CI, 1.01-1.25; P=.03; and aHR, 1.34; 95% CI, 1.10-1.63; P=.004; respectively).
  • In patients receiving intensive BP control, the risk for MACE and stroke was significantly higher in those receiving thiazides than in those not taking thiazides (aHR, 1.49; 1.18-1.88; P<.001 and ahr ci p respectively>

Limitations

  • Observational study design.
  • Risk of residual bias.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit