The Pharmaceutical Journal
Vol 268 No 7193 p487-492
13 April 2002

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Journal of the American Medical Association (jama.ama-assn.org)

Diuretics benefit certain patients

Diuretic therapy is more effective in lowering risk of myocardial infarction (MI) or stroke than other antihypertensives in patients with a specific genetic variation, researchers have found.

Dr Bruce Psaty, cardiovascular health research unit, University of Washington, and colleagues assessed the relationship between diuretic therapy and variations in a-adducin genotype on risk of MI or stroke. A total of 323 cases (patients who had experienced either MI or stroke) and 715 controls were included in the study. One variation of the a-adducin genotype causes high rates of renal reabsorption of sodium and has been associated with hypertension. Presence of this variation was found in one-third of study participants.

Among patients without the adducin genetic variation, diuretic therapy was not associated with a change in risk of stroke or MI. However, among the 385 carriers of the adducin variant allele, diuretic therapy was associated with a lower risk of the combined outcome of MI and stroke than other antihypertensive therapies (odds ratio 0.49, 95 per cent confidence interval 0.32–0.77).

The researchers comment that changes in blood pressure level did not appear to be the mechanism of the adducin-diuretic interaction. "We do not know by what mechanism diuretic use may preferentially reduce the risk of MI or stroke in hypertensive patients with the adducin variant. None the less, the effect of diuretics, which promote renal sodium excretion, is the opposite of the physiological effect of the adducin variant, which promotes renal sodium reabsorption," they comment (JAMA 2002;287:1680).