Additional small amounts of diuretics improve blood pressure control at low cost without disadvantages in blood sugar metabolism.

We evaluated our present treatment of hypertension and sought a way to improve it. We studied 164 of outpatients we treated in 2002. Mean systolic blood pressure (SBP)+/-SD was 142.0+/-11.3, and 56% of patients had SBP over 140 mmHg. We used more diuretics in patients with good control of SBP (19% vs. 7% of patients; p=0.012). After observing our hypertensive patients, we changed our treatment in a goal-oriented manner. Our goal was blood pressure below 140/90 mmHg. We used, in principle, additional small amounts of diuretics for inadequately treated patients. We followed 147 of the 164 patients from 2002 to 2006. During this period, mean SBP decreased to 134.7+/-9.1 mmHg (p<0.001), and the frequency of patients with SBP>140 mmHg decreased to 14% (p<0.001). We used more diuretics in 2006 than in 2002 (12% to 46% p<0.001). To estimate the risks and benefits of diuretics, in 2006 we analyzed 510 patients who had been followed for at least 2 years. Potassium supplementation was needed in 28% of diuretic-treated patients and 7% of patients without diuretics. We found a correlation between the use of diuretics and good SBP control in the entire patient group as well as in patients with diabetes. In the control of diabetes mellitus, we found no statistical difference between patients treated with diuretics and those not. We found diuretics had no adverse effects with respect to new-onset diabetes mellitus.