Angiotensin-receptor blockers (ARBs) and angiotensin-converting-enzyme inhibitors (ACE) are the antihypertensive agents least associated with incident diabetes according to an Article in this week's Lancet.
The propensity for some blood pressure-lowering drugs to reduce glucose tolerance and precipitate diabetes is well known. Some long-term clinical trials comparing antihypertensive agents have shown significant differences in the rates of new cases of diabetes between treatment groups.
To investigate, William Elliott (Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA) and Peter Meyer undertook a network meta-analysis* to assess the relative odds of developing diabetes during long-term treatment with each initial class of antihypertensive drugs or placebo, on the basis of the reported number of participants with, and at risk of, incident diabetes in randomised trials. They undertook a systematic review up to September 15, 2006, and identified 22 clinical trials with 143 153 participants who did not have diabetes at randomisation. They found that the association of antihypertensive drugs with incident diabetes was lowest for ARBs and ACE inhibitors followed by calcium-channel blockers and placebo, and then beta-blockers and diuretics in rank order.
The authors conclude: "This technique not only includes results of all clinical trials that directly compared two initial antihypertensive drugs, but also incorporates indirect comparisons (particularly important for ACE inhibitors versus ARBs, which have not yet been directly compared), and results in estimates that are highly coherent and robust to many sensitivity analyses."
The Lancet