Comparison of single & combined diurectics in low-renin hypertension

• Research type

  Research Study

• Full title

  Comparison of single & combined diurectics in low-renin hypertension

• IRAS ID

  17100

• Sponsor organisation

  Cambridge University Hospitals NHS Foundation Trust and the University of Cambridge

• Eudract number

  2009-010068-41

• ISRCTN Number

  UKCRN 4501

• Research summary

  The identity of optimal diuretic, and whether this varies among individuals or groups, is largely unknown. Almost certainly it is neither bendfluethiazide 2.5 mg, which is sub-maximal, nor bendfluethiazide 5 mg which substantially increases the risk of diabetes. In our recent crossover comparisons of diuretics, amiloride and spironolactone at sufficient dose were as effective as bendfluethiazide 5 mg. However, there is only anecdotal data to suggest they are less diabetogenic - perhaps, even, protective - and this would be a minimum requirement to offset the weight of outcome data underpinning thiazide usage. The primary hypothesis of our third study is that in patients with volume-dependent hypertension, a combination of diuretics at correct dose is substantially more effective than single diuretics at their conventional maximal dose, and cancels out the risks of K+disorders and new-onset diabetes. Because the diuretics and doses in current use are not those studied in the large outcome trials, a substantial difference in efficacy (BP) or tolerability (glucose tolerance) in several hundred patients should flunce practice, without waiting for the longer-term outcome trials that might follow.

• REC name

  East of England - Cambridge South Research Ethics Committee

• REC reference

  09/H0305/19

• Date of REC Opinion

  14 May 2009

• REC opinion

  Further Information Favourable Opinion