Antihypertensive treatment in insulin resistant patients

Epidemiological evidence suggests that treatment with beta-blockers and diuretics increase the risk to develop diabetes. Prospective, randomized studies of antihypertensive drugs have demonstrated differences between different classes of drugs regarding effects on insulin sensitivity. Thus treatment with beta-blockers or diuretics is associated with impairment in insulin sensitivity, whereas most modern calcium-channel blockers and angiotensin converting enzyme inhibitors are neutral. However, captopril treatment seems to be different and result in improvement of insulin sensitivity. The most pronounced improvements have been obtained with alpha1-blockers. In populations at high risk for diabetes, it may be justified to select drugs that improve insulin sensitivity when treating hypertension in insulin resistant individuals.