Predictors of development of diabetes mellitus in patients with coronary artery disease taking antihypertensive medications (findings from the INternational VErapamil SR-Trandolapril STudy [INVEST]).
Knowledge of predictors of diabetes mellitus (DM) development in patients with coronary artery disease (CAD) who use antihypertensive therapy could contribute to decreasing this adverse metabolic consequence. This is particularly relevant because the standard of care, beta blockers combined with diuretics, may contribute to adverse metabolic risk. The INternational VErapamil SR-trandolapril STudy compared a calcium antagonist-based (verapamil SR) and a beta-blocker-based (atenolol) strategy with trandolapril and/or hydrochlorothiazide added to control blood pressure (BP) in patients with CAD. The 16,176 patients without DM at entry were investigated with regard to newly diagnosed DM during follow-up. Newly diagnosed DM was less frequent in the verapamil SR versus atenolol strategy (7.0% vs 8.2%, hazard ratio 0.85, 95% confidence interval 0.76 to 0.95, p <0.01). Characteristics associated with risk for newly diagnosed DM included United States residence, left ventricular hypertrophy, previous stroke/transient ischemic attack, Hispanic ethnicity, coronary revascularization, hypercholesterolemia, greater body mass index, and higher follow-up systolic BP. Addition of trandolapril to verapamil SR decreased DM risk and addition of hydrochlorothiazide to atenolol increased risk. In conclusion, clinical findings associated with more severe vascular disease and Hispanic ethnicity identify a group at high risk for developing DM, whereas lower on-treatment BP and treatment with verapamil SR-trandolapril attenuated this risk.
Cooper-Dehoff
Rhonda
R
University of Florida College of Medicine, Gainesville, Florida, USA.
Cohen
Jerome D
JD
Bakris
George L
GL
Messerli
Franz H
FH
Erdine
Serap
S
Hewkin
Ann C
AC
Kupfer
Stuart
S
Pepine
Carl J
CJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use; D015992:Body Mass Index; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000453:epidemiology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology; D007211:Indoles / Q000627:therapeutic use; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D009204:Myocardial Revascularization; D012111:Residence Characteristics; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013599:Systole; D014700:Verapamil / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D007211:Indoles; D006852:Hydrochlorothiazide; C052035:trandolapril; D001262:Atenolol; D014700:Verapamil