Antihypertensive medications and risk of diabetes mellitus.
OBJECTIVE
Over the past decade post-hoc analyses of clinical trials and observational studies have tended to show that participants treated with thiazide diuretics are at greater risk for newly diagnosed diabetes mellitus than those treated with other medication classes. We review the results of several recent studies on the impact of thiazide-related hyperglycemia and diabetes mellitus on cardiovascular disease outcomes. We also examine the impact of the glucose-sparing effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on preventing cardiovascular disease.


RESULTS
No consistent or conclusive evidence has been found that hyperglycemia or diabetes mellitus in association with thiazide diuretic use is associated with increased cardiovascular disease outcomes. This benign outcome may be a consequence of the fact that only a segment of such diuretic-associated cases is induced by the usual etiologic mechanisms that are associated with classic 'diabetes mellitus'. Likewise, no evidence has been found that the glucose-lowering effect of angiotensin-converting enzyme inhibitors is associated with decreased cardiovascular disease risk.


CONCLUSIONS
We conclude that thiazide diuretics are safe to use, even in hypertensive individuals at risk for incident glucose disorders. The use of angiotensin-converting enzyme inhibitors for protection against glucose disorders and subsequent cardiovascular disease remains to be determined.
Barzilay
Joshua I
JI
Kaiser Permanente of Georgia and the Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, USA. joshua.barzilay@kp.org
Cutler
Jeffrey A
JA
Davis
Barry R
BR
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000139:chemically induced*; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced* / Q000150:complications; D006973:Hypertension / Q000188:drug therapy*; D018570:Risk Assessment; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000009:adverse effects*
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D049993:Sodium Chloride Symporter Inhibitors