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New-onset diabetes and antihypertensive drugs
Giuseppe Mancia1, Guido Grassi, Alberto Zanchetti
1Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano, Bicocca, Italy. giuesppe,mancia@unimib.it
Abstract:
Observational studies have provided evidence that a consistent fraction (approximately 15-20%) of hypertensive patients displays a glucose intolerance state that may be aggravated by antihypertensive drug regimens based on thiazide diuretics or beta-blockers. This review examines the relative and absolute diabetogenic effects of antihypertensive drugs, by comparing the impact of 'new' (calcium antagonists, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists) versus 'old' (diuretics and beta-blockers) drugs on new-onset diabetes in recent clinical trials. Evidence is provided that compared with diuretics and beta-blockers, new-onset diabetes is less common with 'new' drugs, and that conventional antihypertensive compounds, particularly when combined together, may amplify the natural time-dependent tendency towards the development of this metabolic disease. This paper provides new insights into the potential mechanisms responsible for the phenomenon and the clinical significance of antihypertensive drug-induced diabetes.
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