P3209Calcium channel blocker monotherapy versus combination with renin-angiotensin system blockers in the development of new-onset diabetes mellitus in hypertensive Korean patients

Abstract

BackgroundIn real practice, two or more antihypertensive drugs are needed to achieve target blood pressure. We investigated the comparative beneficial actions of combination therapy of renin-angiotensin system inhibitors (RASI), with calcium channel blockers (CCB) over CCB monotherapy on the development of new-onset diabetes mellitus (NODM) in Korean patients during four-year follow-up periods.MethodsA total of 3208 consecutive hypertensive patients without a history of diabetes mellitus who had been prescribed CCB were retrospectively enrolled from January 2004 to December 2012. These patients were divided into the two groups according to the additional use of RASI (the RASI group, n = 1221 and the no RASI group, n = 1987). Primary endpoint was NODM, defined as a fasting blood glucose ≥ 126 mg/dL or hemoglobin A1c ≥ 6.5%. Secondary endpoint was major adverse cardiac events (MACE) defined as total death, myocardial infarction (MI) and percutaneous coronary intervention (PCI).ResultsAfter propensity score-matched (PSM) analysis, two propensity-matched groups (939 pairs, n = 1878, C-statistic = 0.743) were generated. The incidences of NODM (HR = 1.009, 95% CI: 0.700–1.452, P = 0.962), MACE (HR = 0.877, 95% CI: 0.544–1.413, P = 0.589), total death, MI, PCI were similar between the two groups after PSM during four years.ConclusionsThe use of RASI in addition to CCB showed comparable incidences of NODM and MACE compared to CCB monotherapy in non-diabetic hypertensive Korean patients during four-year follow-up period. However, large-scaled randomized controlled clinical trials will be required for a more definitive conclusion.

Fixed‐dose combination of amlodipine and atorvastatin improves clinical outcomes in patients with concomitant hypertension and dyslipidemia

“…In contrast, treatment with CCBs is associated with a higher risk of developing NODM when compared with both ACEI and ARB treatment 33,34 . However, the use of ARB or ACEI in addition to CCB has demonstrated comparable incidences of NODM when compared to CCB monotherapy 36 . The drug‐drug interaction between CCBs and statins on the development of NODM remains unclear and is yet to be evaluated.…”

The Peculiarity of Process and Treatment of Arterial Hypertension in Patients with Type 2 Diabetes Mellitus

“…Не менее существенным преимуществом стартовой комбинированной АГТ остается комплексное влияние на различные патогенетические механизмы, что, безусловно, важно в дебюте заболевания, способствует более длительному удержанию целевых уровней АД и характеризуется более выраженной органопротекцией [14]. Так, при сравнении комбинации блокатора РААС с БКК и монотерапии БКК у пациентов с СД и АГ отмечается дополнительное снижение общей смертности на 5,2%, сердечно-сосудистой смертности на 0,7%, риск развития инфаркта миокарда -на 0,9% [24]. Данная комбинация снижала креатинин на 4,08 ммоль/л и повышала СКФ на 4,13 мл/мин/1,73 м 2 у пациентов с СД и ХБП [25].…”