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Therapeutic Research
- Authors: Masahiko Igarashi1, et al
Abstract
Background and objective:Congestive heart failure(CHF)occurs frequently in diabetic patients, and its prevention is required to reduce mortality and morbidity. Plasma brain natriuretic peptide(BNP)has recently been considered to be a useful biomarker for the prediction of CHF, and some agents such as diuretics may reduce BNP in patients with chronic CHF. However, these agents are not generally accepted for diabetic patients due to their unfavorable metabolic effects, including the elevation of plasma glucose, serum lipids, and serum uric acid(SUA). This study investigates whether diuretics alter BNP level, and simultaneously cause adverse metabolic effects, especially, on SUA, in Type 2 diabetic patients.Research design and methods:Twenty−four diabetic patients with coronary heart disease, with mean BNP levels of 116.9±17.8 pg/mL, were given 20 mg of furosemide or 2mg of trichlormethiazide once daily for 6 months. Blood pressures were measured and blood samples were taken each month for the measurement of laboratory parameters, including HbA1c, serum lipids, SUA and BNP.Results and discussion:Treatment with the diuretics significantly decreased systolic blood pressure and BNP level. Although the diuretic agents temporarily elevated the levels of HbA1c and serum lipids, these clinical parameters were shown not to have significantly changed at the end of the study. In contrast, diuretics significantly and continuously elevated the SUA level. Interestingly, we identified 8 subjects to a group in whom the SUA level at Month 1 was more than 10% higher than baseline. The other 16 subjects were assigned to a second unchanged SUA group. Although there was no relationship between the relative changes in BNP and SUA, the presence of fatty liver in the first changed SUA group was significantly higher. These results suggest that diuretics may be one of the most promising agents for the prevention of CHF in diabetic patients as long as their administration is carefully selected.
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