Clinical Outcomes in Antihypertensive Treatment of Type 2 Diabetes, Impaired Fasting Glucose Concentration, and Normoglycemia

Results There was no significant difference in relative risk (RR) for the primary outcome in DM or NG participants assigned to amlodipine or lisinopril vs chlorthalidone or in IFG participants assigned to lisinopril vs chlorthalidone. A significantly higher RR (95% confidence interval) was noted for the primary outcome in IFG participants assigned to amlodipine vs chlorthalidone (1.73 [1.10-2.72]). Stroke was more common in NG participants assigned to lisinopril vs chlorthalidone (1.31 [1.10-1.57]). Heart failure was more common in DM and NG participants assigned to amlodipine (1.39 [1.22-1.59] and 1.30 [1.12-1.51], respectively) or lisinopril (1.15 [1.00-1.32] and 1.19 [1.02-1.39], respectively) vs chlorthalidone.

Conclusion: Our results provide no evidence of superiority for treatment with calcium channel blockers or angiotensin-converting enzyme inhibitors compared with a thiazide-type diuretic during first-step antihypertensive therapy in DM, IFG, or NG.

You say, and I agree,
“The key to stroke prevention is BP control.”

Elevated BP causes strokes.

For the outcome of stroke: what is the Number Needed to Harm (NNH) when starting ACE-I before a thiazide.

My major point is this – a large number of patients cannot afford ACE-I. Physicians should inform patients of the pluses/minuses of starting ACE-I vs thiazide. This discussion should include COST of medications. With the extra money patients would have with the thiazides, why not prescribe the diuretic and a gym membership.

Thiazide + Gym membership is still cheaper than the ACE-I.

Not to mention, the exercise they get at the gym is the real answer to long term weight management and bp control.

Keeps the trolls (family members) from leaving stupid questions.