Differential effects of antihypertensive drugs on new-onset diabetes?
Since the late 1950s, new-onset diabetes has been a recognized adverse effect of some antihypertensive drugs. Although diagnostic criteria for diabetes mellitus have changed greatly since then, epidemiologic and physiologic studies suggest that there are differences in glucose tolerance and incident diabetes across antihypertensive drug classes. Data about incident diabetes are now available from 16 long-term, randomized, clinical trials of antihypertensive drugs. From traditional meta-analyses, the rank-ordering of the drug classes is: beta-blocker approximately thiazide diuretic > placebo approximately calcium antagonist > angiotensin-converting enzyme (ACE) inhibitor approximately angiotensin receptor blocker (ARB). Earlier studies indicated that most individuals who developed incident diabetes were "pre-diabetic" before beginning antihypertensive therapy, and ipso facto had increased cardiovascular risk compared with individuals with normal glucose tolerance. An earlier diagnosis of diabetes mellitus generally has little impact (over 5 years) on cardiovascular risk. The clinical importance of differential effects of antihypertensive drugs on incident diabetes is, therefore, much less clear.
Elliott
William J
WJ
Department of Preventive Medicine, RUSH Medical College of RUSH University at RUSH University Medical Center, Chicago, IL 60612, USA. welliott@rush.edu
D000959:Antihypertensive Agents / Q000009:adverse effects / Q000145:classification / Q000378:metabolism* / Q000627:therapeutic use; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000378:metabolism* / Q000517:prevention & control; D005951:Glucose Tolerance Test; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D011236:Prediabetic State / Q000097:blood / Q000378:metabolism*; D013997:Time Factors
D000959:Antihypertensive Agents; D001786:Blood Glucose