Spironolactone Add-On for Preventing or Slowing the Progression of Diabetic Nephropathy: A Meta-Analysis.

Clin Ther. 2015 Aug 4. pii: S0149-2918(15)00847-4. doi: 10.1016/j.clinthera.2015.05.508.Spironolactone Add-On for Preventing or Slowing the Progression of Diabetic Nephropathy: A Meta-Analysis. Hou J , Xiong W , Cao L , Wen X , Li A .

Abstract The aim of this meta-analysis was to evaluate the benefits and potential adverse effects of adding spironolactone to standard antidiabetic/renoprotective/antihypertensive (AD/RP/AHT) treatment in patients with diabetic nephropathy (DN). PubMed/MEDLINE and Web of Knowledge were searched for relevant randomized, controlled studies (RCTs) or quasi-RCTs of the effects of adding spironolactone to standard AD/RP/AHT treatment in patients with DN. Results were summarized with a random-effects model or a fixed-effects model. According to the outcomes measured (benefits and risks of adding spironolactone to standard AD/RP/AHT treatment), compared with controls, the addition of spironolactone significantly decreased end-of-treatment (EOT) 24-hour urinary albumin/protein excretion and significantly increased percentage reduction from baseline in urinary albumin/creatinine ratio (UACR), although it did not significantly affect EOT UACR. The addition of spironolactone further led to a significantly greater reduction from baseline in glomerular filtration rate (GFR)/estimated (e) GFR, although it did not significantly affect EOT GFR/eGFR. Further, the addition of spironolactone significantly reduced EOT in-office, 24-hour, and daytime systolic and diastolic blood pressure (SBP and DBP, respectively) and led to significantly greater reductions from baseline in in-office SBP and DBP, although it did not significantly affect nighttime SBP or DBP. Finally, the addition of spironolactone significantly increased mean serum/plasma potassium levels and the risk for hyperkalemia. Spironolactone could be added to preexisting AD/RP/AHT therapy in patients with DN to prevent or slow DN progression by reducing proteinuria. The addition of spironolactone would likely provide even more beneficial effect in patients with DN and hypertension due to the BP reduction associated with spironolactone use. However, the beneficial effects of spironolactone add-on should be weighed against its potential risks, especially hyperkalemia. The long-term effects of spironolactone add-on on renal outcomes and mortality need to be studied. Copyright © 2015. Published by Elsevier Inc.

HIDROCLOROTIAZIDA O CLORTALIDONA

Cleveland Clinic Journal of medicine Thiazide and thiazidelike diuretics play an important role in managing hypertension in most patients. The eighth Joint National Committee guidelines do not recommend either hydrochlorothiazide or chlorthalidone over the other. The target dose recommendations are hydrochlorothiazide 25 to 50 mg or chlorthalidone 12.5 to 25 mg daily, with lower doses considered for the elderly.

PREDIABETES Y SU ASOCIACION CON INFARTO MIOCARDICO SILENTE

PREDIABETES Y SU ASOCIACION CON INFARTO MIOCARDICO SILENTE
tacey RB, et al. – With one–quarter of initial myocardial infarctions (MI) being unrecognized MI (UMI), recognition is critical to minimize further cardiovascular risk. Diabetes mellitus (DM) is an established risk factor for UMI. If impaired fasting glucose (IFG) also increased the risk for UMI, it would represent a significant public health challenge due to the rapid worldwide increase in IFG prevalence. The authors compared participants with IFG to those with normal fasting glucose (NFG) to determine if IFG was associated with UMIs. Impaired fasting glucose is associated with unrecognized myocardial infarctions in a multi–ethnic population free of baseline cardiovascular disease.

Methods

They performed cross-sectional analyses from the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based cohort study. There were 6,814 participants recruited during July 2000 to September 2002 from the general community at 6 field sites. After excluding those with diabetes mellitus or missing variables, 5,885 participants were included. At baseline, there were 4,955 participants with NFG and 930 participants with IFG. The main outcome was an UMI defined by the presence of pathological Q waves or minor Q waves with ST-T abnormalities on initial 12-lead electrocardiogram (ECG). Logistic regression was used to generate crude odds ratios and adjust for covariates.

Results

There was a higher prevalence of UMI in those with IFG compared with those with NFG [3.5% (n = 72) vs 1.4% (n = 30)]. After adjustment for multiple risk factors, there was a higher odds of an UMI among those with IFG compared with those with NFG [OR: 1.60 (95% CI: 1.0-2.5); p = 0.048].