Diuretic thiazide and prevention of hip fracture in hypertensive postmenopausal women.

Cardiovascular complications and osteoporosis are the two major risks after menopause. Osteoporosis is a decrease in bone mass density (BMD) and its major complication is hip fracture which represents an important cause of morbidity and mortality. Thiazide diuretics, by reducing urinary excretion of calcium, could preserve the BMD and could be an appropriate treatment for hypertensive post menopausal women and elderly patients (pt). 99 hypertensive women were enrolled into a two-year, controlled, double-blind trial, and were randomised in two groups receiving either captopril 50mg/day (CA), or captopril 50mg + hydrochlorothiazide 25mg/day (CA/HCTZ). At baseline (D 0), they were homogeneous in terms of age, height, weight, duration of hypertension, diastolic and systolic pressure and BMD. Recruitment criteria were: moderately hypertensive females, menopaused since at least two years duration (no hormone replacement therapy), no evidence of osteoporosis (normal value of BMD), normal phosphocalcium and renal evaluations. Assessment criteria on D0, D180, D360, D720: measurement of BMD (by dual X-ray absorptiometry: DPX, LUNAR) and blood pressure (according to the protocol, adjunction of rilmenidine (R) or nitrendipine (N) was allowed in case of persistent hypertension). Analysis of efficacy on an intent-to-treat basis was performed in 87 pts (42 pts in CA, and 45 pts in CA/HCTZ), mean age 63 ± 7,2 (SD) years, mean BMI 25,93 ± 4,1 kg/m2, mean follow-up duration 690,4 ± 125,7 days. Comparisons between the 2 treatments groups (primary efficacy analysis) and comparisons between each group and a age-, weight-, non hypertensive-matched population (secondary efficacy analysis) were performed on an intent - to - treat basis. Results showed: (1) a decrease in bone demineralisation in CA/HCTZ versus CA group at the femoral neck level. This decrease could also be observed at the wardʹs triangle level where the risk of hip fracture is higher (2) Adjunction of R or N was necessary in 3 pts in CA/HCTZ group and 11 in the CA group (p = 0,013). In conclusion, HCTZ appears to exert a beneficial effect on femoral neck and Wardʹs triangle BMD, and may be the appropriate antihypertensive treatment in postmenopausal women.