|Year : 2011 | Volume
| Issue : 1 | Page : 73-77
Effects of hydrochlorothiazide on K-dependent pancreatic response and the correlations with blood sugar, insulin in patients with essential hypertension
Molecular Science and Biomedical Unit and Department of Pharmacology, Faculty of Medicine, University of Ruhuna, Sri Lanka
|Date of Submission||24-Oct-2010|
|Date of Acceptance||06-Dec-2010|
|Date of Web Publication||11-Mar-2011|
L M Hettihewa
Molecular Science and Biomedical Unit and Department of Pharmacology, Faculty of Medicine, University of Ruhuna
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Context: To study the onset of the development of glucose intolerance and the mechanism by hydrochlorothiazide (HCT). Settings and Design: Hypertensive patients (n = 120) who were treated with captopril (CP) 25 mg daily were randomly divided into two groups. Materials and Methods: The control group was on captopril (n = 60) and the test group was given 25 mg HCT. They were followed for six months and the levels of fasting blood sugar (FBS), fasting insulin (FI) , and fasting potassium (FK) were analyzed, to calculate the correlation coefficient. Results: There were no significant correlations between FBS and FI or FI, with FK in both groups at baseline. The changes in the FBS or FI levels during the first three months were not significant in both the test and control groups. Reduction of FK was significant (P < 0.05) and had a positive correlation with FBS after three months (r = + 0.78, P < 0.05) in the test group. Correlations between FI and FBS or FK were not significant. FBS was significantly increased (P < 0.05) in the test group after six months. Both FI and FK had developed significant correlations with FBS in the HCT-treated group (r = - 0.71 with FI and r = + 0.77 with FK, respectively, P < 0.05) after six months. Reduction of FI was positively correlated with the FK test group (r = + 0.83, P < 0.05) after six months. Conclusions: HCT induced hypokalaemia in the early phase and developed hyperglycemia and hyperinsulinemia in the late phase. This suggested that HCT initially influenced pancreatic response to glucose, which was dependent on serum K and was probably mediated by hypoinsulinemia. We suggest large scale studies for further investigations on this relationship.
Keywords: Essential hypertension, hydrochlorothiazide, insulin, and serum
|How to cite this article:|
Hettihewa L M. Effects of hydrochlorothiazide on K-dependent pancreatic response and the correlations with blood sugar, insulin in patients with essential hypertension. Int J Nutr Pharmacol Neurol Dis 2011;1:73-7
|How to cite this URL:|
Hettihewa L M. Effects of hydrochlorothiazide on K-dependent pancreatic response and the correlations with blood sugar, insulin in patients with essential hypertension. Int J Nutr Pharmacol Neurol Dis [serial online] 2011 [cited 2020 Mar 31];1:73-7. Available from: http://www.ijnpnd.com/text.asp?2011/1/1/73/77536
| Introduction|| |
Prescribing diuretic medication especially thiazides (HCT) in the elderly population need special precautions. HCT, especially, leads to hyponatremia, hyperglycemia, and hypokalemia. ,, Various mechanisms for thiazide-induced hyponatremia have been proposed. ,, The principal mechanism is thought to be through a blockage of sodium chloride co-transport in the proximal part of the distal tubule, leading to excess sodium excretion.  The ongoing loss of sodium without adequate replacement and also the potassium loss in the urine are other contributory causes. , Hyperglycemia due to HCT use is yet thought to be an idiosyncratic reaction. 
During the past decade several studies have shown that a large proportion of patients with hypertension, who were given with HCT, had developed hypokalemia and hyperglycemia as common side effects.  Treatment with β blockers or HCT had also increased insulin resistance,, thereby increasing the risk of developing type 2 diabetes mellitus or impaired glucose tolerance in hypertensive patients. ,
A review of trials in which HCT was used as an antihypertensive treatment concluded that a definite association existed between diuretic treatment and the development of impaired glucose tolerance. ,, Although the association between glucose intolerance and HCT therapy was established, the exact underlying mechanism has yet not been established. The main objective of this study was to identify the mechanism of action of HCT on the development of glucose intolerance in non-diabetic patients. Medical scientists can plan therapeutic strategies to avoid the development of HCT-induced glucose intolerance in patients. After a literature survey, a hypothesis was made on the mechanism of glucose intolerance - that it could be due to the changes in pancreatic functions. Furthermore, we planned to analyze HCT-induced onset of glucose intolerance and the relationship of the development of glucose intolerance with the insulin and potassium levels in patients.
| Materials and Methods|| |
The protocol for this study was approved by the Ethical Committee of the Faculty of Medicine, University of Ruhuna. Hypertensive patients (n = 120) who were treated with captopril (CP) 25 mg daily were randomly divided into two groups. The control group was only on captopril (n = 60) and the other group was given 25 mg HCT. The participants underwent a physical examination, including measurement of height, weight, and radial pulse rate. Overnight fasting blood samples were drawn for the analysis of FBS, FI, and FK. All the patients were given verbal and written information about the study. Clinical history, including age, sex, drugs, smoking and alcohol consumption, level of physical exercise, previous history of diabetes, coronary artery disease, and peripheral vascular disease were obtained. Family history of diabetes was ascertained. The exclusion criteria were age outside the range of 30 - 65 years, hypothyroidism, liver, kidney or heart failure, and neoplasm. They were followed for six months and the FBS (Diagnostica-merck), FI (ELISA - diagnostic automation), and FK Diagnostica-merck) were analyzed at monthly intervals.
For the descriptive statistics, after having checked the normality of the variables using the Kolmogorov-Smirnov test, the usual central and dispersion methods were used: average, standard deviation (SD), and 95% confidence interval (CI) power were carried out based on the results of the current study, comparing changes in FI, FK, and FBS for six months, allowing a declaration of the difference before and after, in same treatment group, at a significant level of alpha = 0.05, with a power of 80%. The statistical significance of differences between the means were evaluated using the paired Student's T-test in case of the normal distribution of data sets, and the Kolmogorov-Smirnov test when the normal distribution was excluded in at least one of the data sets. Correlation between two variables was studied with the Spearman rank-order. All statistical analyses were performed using Microcal origin 4.1 (2005) and Microsoft Excel, whenever applicable.
| Results|| |
The changes in FBS and FI after the first three months of HCT therapy were not statistically significant both in the test and control groups [P > 0.05, [Table 2]]. In contrast, reduction of FK was statistically significant (P < 0.05) within three months.
[Table 1]. [Table 2] presents the means and standard deviations for baseline metabolic characteristics and changes in FBS, FI, and FK with 25 mg of HCT therapy in our study participants. There was no significant difference in weight, FBS, FI, or FK in the control or test groups.
|Table 2 Changes of FI, FBS, and FK in our control and test group at three months|
Click here to view
Correlation between these parameters was also assessed after three months and there was no significant correlation between either FBS and FI or FI and FK, in both groups [Figure 1]a and b.
|Figure 1: The correlation between FI and FK and FI and FBS was analyzed after three months of HCT therapy in our study group|
Click here to view
In contrast, [Figure 2] shows the reduction of FK concentration in the HCT test group after three months. It was statistically significant (P < 005).
The reduction of FK in the study group was also statistically significant [Figure 3]b. In addition to that, FK also had a significant positive correlation with FBS at the end of three months in the HCT-treated group (r = +0.78, P < 0.001, [Figure 3]a). There was no significant correlation in the control group of patients (data not shown).
|Figure 2: Changes of fasting potassium levels with HCT therapy is shown in Figure 2. The difference was statistically signifi cant only in the test group (P < 0.05). Values were given as mean ± SE (y Error Bar)|
Click here to view
|Figure 3: The correlation between FK and FBS is statistically signifi cant in the test group of our patients. Data are scattered and linear regression is analyzed r = +0.78, P < 0.001. Reduction of FI after six months of HCT in the test group is given in 3B. Values are mean ± SE|
Click here to view
There was a significant reduction in FI and FK (P < 0.05, [Table 3]), and FBS was increased significantly in the HCT group after six months [Table 3]. On account of these observations, we extended our study to analyze any correlation between FK and FBS or FK andFI after six months of HCT therapy.
[Figure 4]a and b show that both FI and FK had significant correlations with FBS in the HCT-treated group (r = - 0.71 with FI and r = + 0.77 with FK, respectively. P < 0.05) at six months. Reduction of FI also had a positive correlation with the FK levels in the HCT-treated group (r = + 0.83, P < 0.05, [Figure 4]C), but not in the control.
|Figure 4: The correlations of FI with FK and FBS in our study groups. Correlation values are given in the fi gure|
Click here to view
|Table 3 The FBS, FK, and FI levels after six months of PIO therapy. Data are given as mean ± SE|
Click here to view
| Discussion|| |
In this article we investigated the role of HCT therapy on FBS, FI, and FK levels in hypertensive patients. We observed that HCT therapy caused early reduction of FK before development of GI in the early phase. Changes in FBS and FI were not significant at the end of the third month. Our results showed that HCT-induced GI initially had a negative correlation with FK and later GI had a positive correlation with both FI and FBS.
The present experience suggests that HCT has caused early hypokalemia and late insulinopenia, which has reciprocally induced hypoglycemia. Although there are several original research data available on thiazide diuretic therapy, the correlation and mechanism of the development have not been analyzed by any other researchers.  Therefore, it is yet impossible to find out either supporting or contrasting data, for a comparison with our study.
We hereby strongly suggest that HCT first induced an initial pancreatic response in glucose, which could be dependent on serum K. It had led to the development of late hypoinsulinemia and hyperglycemia during the treatment of hypertensive non-diabetic patients.
In conclusion, the present study indicates that early reduction of FK levels can influence the metabolism of insulin in the pancreas and that initiates a disturbance in the glucose metabolism caused by hypoinsulinemia in the late stages. These disturbances of FK, FI, and FBS induced by HCT are inter-related. A number of patients in our study are limited, for the application of our results on the general population. Related studies are also limited in this area. We are in the progress of conducting large scale studies for confirmation of our results, and strongly recommend others to conduct similar studies.
| References|| |
|1.||Greenberg A. Diuretic complications. Am J Med Sci 2000;319:10-24. |
|2.||Baglin A, Boulard JC, Hanslik T, Prinseau J. Metabolic adverse reactions to diuretics: Clinical relevance to elderly patients. Drug Saf 1995;12:161-7. |
|3.||Sonnenblick M, Friedlander Y, Rosin AJ. Diuretics induced severe hyponatremia: Review and analysis of 129 reported patients. Chest 1993;103:601-6. |
|4.||Kone B, Gimenez L, Watson AJ. Thiazide-induced hyponatremia. South Med J 1986;79:1456-7. |
|5.||Ashraf N, Locksley R, Arieff AI. Thiazide-induced hyponatremia associated with death or neurologic damage in outpatients. Am J Med 1981;70:1163-8. |
|6.||Walter SJ, Laycock JF, Shirley DG. A micropuncture study of proximal tubular function after acute hydrochlorothiazide administration to Brattleboro rats with diabetes insipidus. Clin Sci 1979;57:427-34. |
|7.||Walter S, Shirley DG. Sodium balance and antidiuresis in thiazide treated rats with diabetes insipidus. Eur J Pharmacol 1983;89:283-6. |
|8.||Shirley DG, Walter SJ, Laycock JF. The role of sodium depletion in hydrochlorothiazide-induced antidiuresis in Brattleboro rats with diabetes insipidus. Clin Sci Mol Med 1978;54:209-15. |
|9.||Grønbeck L, Marples D, Nielsen S, Christensen S. Mechanism of antidiuresis caused by bendroflumethiazide in conscious rats with diabetes insipidus. Br J Pharmacol 1998;123:737-45. |
|10.||Lunau HE, Bak M, Petersen JS, Shalmi M, Marcussen N, Christensen S. Renal adaptations to constant administration of furosemide and bendrofluaethiazide in rats. Pharmacol Toxicol 1994;74:216-22. |
|11.||Salman AL. Hyponatremic encephalopathy induced by thiazide diuretics. West J Med 2001;175:87. |
|12.||Zillich AJ, Garg J, Basu S, Bakris GL, Carter BL. Thiazide diuretics, potassium, and the development of diabetes a quantitative review. Hypertension 2006;48:219-24. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]