The "take home" in a nutshell:
Their findings showed that the lowest risk for new-onset diabetes occurred with
AII receptor antagonists (OR=0.57; 95% CI, 0.46-0.72),
which were better but not significantly better than ACE inhibitors (OR=0.67; 95% CI, 0.56-0.80)
followed by calcium channel blockers (OR=0.75; 95% CI, 0.62-0.90) and
placebo (OR=0.77; 95% CI, 0.63-0.94).
The risk was highest with diuretics and beta-blockers (OR=0.90; 95% CI, 0.75-1.09),
according to Elliott.
Endocrine Today
Their findings showed that the lowest risk for new-onset diabetes occurred with
AII receptor antagonists (OR=0.57; 95% CI, 0.46-0.72),
which were better but not significantly better than ACE inhibitors (OR=0.67; 95% CI, 0.56-0.80)
followed by calcium channel blockers (OR=0.75; 95% CI, 0.62-0.90) and
placebo (OR=0.77; 95% CI, 0.63-0.94).
The risk was highest with diuretics and beta-blockers (OR=0.90; 95% CI, 0.75-1.09),
according to Elliott.
Endocrine Today
Hypertension treatment with angiotensin II receptor antagonists and ACE inhibitors is least likely to lead to diabetes; however, diuretics or beta-blockers increase a patient’s chance of developing diabetes, according to a report published in The Lancet.
“We should monitor our patients for the development of diabetes, and we should remain cognizant that different medicines have different propensities. But we should use all the medicines necessary to get and keep blood pressure under control,” said William J. Elliott, MD, PhD, professor of preventive medicine, internal medicine and pharmacology at Rush Medical College of Rush University Medical Center, Chicago.
Several long-term clinical trials have shown that patients on antihypertension medications are more likely to have reduced glucose tolerance and precipitated new-onset diabetes than those without hypertension. This is often attributed to increased weight, recent weight gain or stronger family history of diabetes among those with hypertension.
Elliott and colleagues analyzed data to assess the relationship between long-term treatment with classes of antihypertensive drugs and incident diabetes.
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Evaluating a relationship
The researchers conducted a network meta-analysis of long-term, randomized clinical trials from 1966 to 2006 among 143,153 participants who did not have diabetes at randomization. They identified 22 clinical trials of each class of antihypertensive drugs. They assessed the chance that a person would develop diabetes during one to about five years of observation.
Their findings showed that the lowest risk for new-onset diabetes occurred with AII receptor antagonists (OR=0.57; 95% CI, 0.46-0.72), which were better but not significantly better than ACE inhibitors (OR=0.67; 95% CI, 0.56-0.80) followed by calcium channel blockers (OR=0.75; 95% CI, 0.62-0.90) and placebo (OR=0.77; 95% CI, 0.63-0.94). The risk was highest with diuretics and beta-blockers (OR=0.90; 95% CI, 0.75-1.09), according to Elliott. Compared with placebo, diuretics or beta-blockers slightly but significantly increased the risk for developing diabetes. AII receptor antagonists or ACE inhibitors significantly decreased the risk. These findings suggest that the differences between antihypertensive drugs and the risk for new-onset diabetes are real and significant.
“Don’t throw out the blood pressure medicines because you are worried about the risk for getting diabetes; instead, monitor patients,” Elliott advised. “It is certainly important when you find out a patient has diabetes because it changes their blood pressure target and their cholesterol target, and they probably ought to always be on aspirin after that.”
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