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

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, 2.15; 95% CI, 1.47-3.32; P<.001, respectively).   

Limitations

• Observational study design.
• Risk of residual bias.