1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Antihypertensive Drugs and Risk for Diabetes

Prospective data from three large cohorts add to the evidence that thiazide diuretics and ß-blockers can cause glucose intolerance.

In several studies, thiazide diuretics and ß-blockers have been associated with increased incidence of diabetes. Now, researchers have examined this association in three large prospective observational studies, the Nurses' Health Studies I and II and the Health Professionals Follow-up Study. About 75,000 participants with hypertension, but not diabetes, were followed for 8 to 16 years. New-onset diabetes was reported by 3589 participants during follow-up.

After adjustment for potentially confounding variables, thiazide use (compared with non-use) was associated independently with increased risk for incident diabetes; relative risk ranged from 1.2 to 1.5, depending on the cohort. ß-blocker use was associated with increased diabetes risk in men and in older women (RRs, 1.2 and 1.3, respectively). No association was noted between use of calcium-channel blockers and diabetes risk. Angiotensin-converting–enzyme (ACE) inhibitor use, recorded only in older women, also was not associated with diabetes.

Comment: This study reinforces previous research suggesting that thiazide diuretics and ß-blockers can cause glucose intolerance. In the randomized ALLHAT trial, thiazide users were more likely to develop diabetes than were users of calcium-channel blockers and ACE inhibitors, yet their mortality and cardiovascular morbidity rates were not increased (Journal Watch Jan 14 2003). Nevertheless, these results raise questions about whether we should lean toward drugs other than thiazides and ß-blockers when choosing first-line antihypertensives for patients with impaired glucose tolerance.

— Allan S. Brett, MD

Published in Journal Watch General Medicine May 30, 2006

Citation(s):

Taylor EN et al. Antihypertensive medications and the risk of incident type 2 diabetes. Diabetes Care 2006 May; 29:1065-70.

• Original article (Subscription may be required)
• Medline abstract (Free)