Fasting Glucose Levels and Incident Diabetes Mellitus in Older Nondiabetic Adults Randomized to Receive 3 Different Classes of Antihypertensive Treatment

Barzilay, Joshua I.; Davis, Barry R.; Cutler, Jeffrey A.; Pressel, Sara L.; Whelton, Paul K.; Basile, Jan; Margolis, Karen L.; Ong, Stephen T.; Sadler, Laurie S.; Summerson, John H.

doi:10.1001/archinte.166.20.2191

Cited by 246 publications

(117 citation statements)

References 28 publications

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“…In spite of this unfavorable biochemical finding, the change in fasting glucose levels did not adversely impact CVD outcomes, a finding similar to what we found in the nondiabetic cohort of ALLHAT (15). The possibility has been raised that had ALLHAT been extended to 10 or 15 years of follow-up, the negative effect of elevated fasting glucose levels and the dyslipidemia associated with diuretic use would have become evident (29). The recent report from the 14-year follow-up of the Systolic Hypertension in the Elderly Program (SHEP) does not support this argument (30).…”

Section: Biochemical Changessupporting

confidence: 82%

Metabolic and Clinical Outcomes in Nondiabetic Individuals With the Metabolic Syndrome Assigned to Chlorthalidone, Amlodipine, or Lisinopril as Initial Treatment for Hypertension

et al. 2008

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OBJECTIVE -Optimal initial antihypertensive drug therapy in people with the metabolic syndrome is unknown. RESEARCH DESIGN AND METHODS -We conducted a subgroup analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) to compare metabolic, cardiovascular, and renal outcomes in individuals assigned to initial hypertension treatment with a thiazide-like diuretic (chlorthalidone), a calcium channel blocker (CCB; amlodipine), or an ACE inhibitor (lisinopril) in nondiabetic individuals with or without metabolic syndrome.RESULTS -In participants with metabolic syndrome, at 4 years of follow-up, the incidence of newly diagnosed diabetes (fasting glucose Ն126 mg/dl) was 17.1% for chlorthalidone, 16.0% for amlodipine (P ϭ 0.49, chlorthalidone vs. amlodipine) and 12.6% for lisinopril (P Ͻ 0.05, lisinopril vs. chlorthalidone). For those without metabolic syndrome, the rate of newly diagnosed diabetes was 7.7% for chlorthalidone, 4.2% for amlodipine, and 4.7% for lisinopril (P Ͻ 0.05 for both comparisons). There were no differences in relative risks (RRs) for outcomes with amlodipine compared with chlorthalidone in those with metabolic syndrome; in those without metabolic syndrome, there was a higher risk for heart failure (RR 1.55 [95% CI 1.25-1.35]). In comparison with lisinopril, chlorthalidone was superior in those with metabolic syndrome with respect to heart failure (1.31 [1.04 -1.64]) and combined cardiovascular disease (CVD) (1.19 [1.07-1.32]). No significant treatment group-metabolic syndrome interaction was noted.CONCLUSIONS -Despite a less favorable metabolic profile, thiazide-like diuretic initial therapy for hypertension offers similar, and in some instances possibly superior, CVD outcomes in older hypertensive adults with metabolic syndrome, as compared with treatment with CCBs and ACE inhibitors.

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Section: Biochemical Changessupporting

confidence: 82%

Metabolic and Clinical Outcomes in Nondiabetic Individuals With the Metabolic Syndrome Assigned to Chlorthalidone, Amlodipine, or Lisinopril as Initial Treatment for Hypertension

et al. 2008

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“…However, they have been linked to IGT, hyperglycemia more than NODM [61][62][63][64][65][66][67][68][69]. Hydrochlorothiazide or chlorthalidone have been reported to cause hyperglycemia more often than other diuretics, and a higher incidence of NODM was reported with chlorthalidone in the ALLHAT trial after 2 and 4 years follow-up [68].…”

Section: Thiazidementioning

confidence: 99%

Medications affecting glycemic control

Korayem¹

2017

Int Clin Med

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“…33 No association was seen between diuretic-related changes in FBG or NOD at 2 years and CV or renal disease risk over the subsequent 2.9 years. 35 With 4 additional years of follow-up, the ALLHAT investigators reported that thiazide-related NOD carried a lower risk for CV events than NOD developing in patients receiving either of the other 2 treatments. 36 In the Systolic Hypertension in the Elderly Program (SHEP), 4,732 patients who had been randomized to chlorthalidone or placebo were followed up for a mean of 14.3 years.…”

Section: Thiazide Diuretics and Nodmentioning

confidence: 99%

Cardiovascular drugs that increase the risk of new-onset diabetes

Barter

Waters

2014

American Heart Journal

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The prevalence of type 2 diabetes is increasing worldwide, and diabetes is a strong adverse prognostic factor among patients with cardiovascular (CV) disease. Four classes of drugs that are commonly used for CV risk reduction, statins, niacin, thiazide diuretics, and ß-blockers, have been shown to increase the risk of new-onset diabetes (NOD) by 9% to 43% in meta-analyses or large-scale clinical trials. Clinical predictors for drug-related NOD appear to be similar to the predictors that have been described for NOD unrelated to drugs: fasting blood glucose N100 mg/dL and features of the metabolic syndrome such as body mass index N30 kg/m 2 , serum triglycerides N150 mg/dL, and elevated blood pressure, among others. The mechanisms whereby these drugs increase the risk of NOD are incompletely understood, although different hypotheses have been suggested. Lifestyle intervention consisting of diet and exercise has been shown in multiple studies to reduce the risk of NOD by approximately 50%, with persistent benefit during long-term follow-up. In patients at high risk for NOD, niacin should be avoided, and for hypertension, an angiotensin-converting enzyme inhibitor or even a ß 1 -selective blocker might be a better choice than a standard ß-blocker. For thiazide diuretics and particularly statins, benefit in terms of CV event reduction outweighs the risk of NOD. (Am Heart J 2014;167:421-8.) Worldwide, the prevalence of type 2 diabetes continues to increase rapidly, with more than 371 million cases in the year 2012.1 Diabetes is thus becoming a more prevalent risk factor for cardiovascular (CV) disease, and a higher proportion of patients with CV disease have diabetes. Among patients with CV disease, diabetes is a strong adverse prognostic factor. Controlling for blood pressure, low-density lipoprotein cholesterol, and glycosylated hemoglobin (HbA 1C ) levels reduces CV risk in patients with diabetes; however, only a minority of them successfully attains these multiple goals, 2 despite recent increasing use of drug treatment. 3Within this context, it is troublesome that some of the drugs used to reduce CV risk have been shown either to increase the risk of new-onset diabetes (NOD) or to interfere with glucose control in patients with established diabetes. The purpose of this article is to review clinical trial data for 4 commonly used classes of drugs, statins, niacin, thiazide diuretics, and ß-blockers. For each drug class, an attempt will be made to quantify the benefit of treatment and potential harm based on clinical trial results and meta-analyses of trials. The data from these sources documenting the increased risk of NOD with these drugs are summarized in Figure 1. Predictors of NODStudies in different populations have consistently identified the same cluster of risk factors for NOD. Impaired fasting glucose (IFG; defined as a fasting blood sugar from 100 to 125 mg/dL), a family history of diabetes, and features of the metabolic syndrome are associated with an increased risk of NOD.4 Lifestyle factors, low bo...

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Fasting Glucose Levels and Incident Diabetes Mellitus in Older Nondiabetic Adults Randomized to Receive 3 Different Classes of Antihypertensive Treatment

Cited by 246 publications

References 28 publications

Metabolic and Clinical Outcomes in Nondiabetic Individuals With the Metabolic Syndrome Assigned to Chlorthalidone, Amlodipine, or Lisinopril as Initial Treatment for Hypertension

Metabolic and Clinical Outcomes in Nondiabetic Individuals With the Metabolic Syndrome Assigned to Chlorthalidone, Amlodipine, or Lisinopril as Initial Treatment for Hypertension

Medications affecting glycemic control

Cardiovascular drugs that increase the risk of new-onset diabetes

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