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Thiazide and Beta-Blocker Use Linked With Increased Risk for Incident Diabetes

  • Authors: News Author: Emma Hitt, PhD
    CME Author: Charles Vega, MD, FAAFP
  • CME Released: 5/8/2006; Reviewed and Renewed: 5/8/2007
  • Valid for credit through: 5/8/2008
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This article is intended for primary care clinicians, cardiologists, endocrinologists, and other specialists who care for patients with hypertension.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • Identify the antihypertensive agent associated with a higher risk of incident type 2 diabetes in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study.
  • List antihypertensive medications linked to an increased risk for incident diabetes among a cohort of subjects from the NHS and the HPFS.


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  • Emma Hitt, PhD

    Freelance editor for Medscape.


    Disclosure: Dr. Hitt has reported no significant financial interests.


  • Gary Vogin, MD

    Senior Medical Editor, Medscape


    Disclosure: Gary Vogin, MD, has disclosed no relevant financial relationships.

CME Author(s)

  • Charles P Vega, MD

    Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine


    Charles Vega, MD, FAAFP, has disclosed that he has received grants for educational activities from Pfizer.

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Thiazide and Beta-Blocker Use Linked With Increased Risk for Incident Diabetes

Authors: News Author: Emma Hitt, PhD CME Author: Charles Vega, MD, FAAFPFaculty and Disclosures

CME Released: 5/8/2006; Reviewed and Renewed: 5/8/2007

Valid for credit through: 5/8/2008


May 8, 2006 — Thiazide diuretics and beta-blockers appear to be associated with an increased relative risk for incident diabetes, according to a prospective analysis involving hypertensive participants in 3 large cohort studies. By contrast, angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers were not associated with an increased risk.

Eric N. Taylor, MD, with the Brigham and Women's Hospital, and Harvard Medical School, in Boston, Mass, and colleagues reported their findings in the May 2006 issue of Diabetes Care.

"Our study suggests that individuals treated with these medications merit increased surveillance for diabetes," the researchers write.

Dr Taylor and colleagues conducted a prospective study of participants from the Nurses' Health Study (NHS) I, the NHS II, and the Health Professionals Follow-up Study (HPFS). Participants were questioned about their use of antihypertensives once every 2 years.

All subjects had hypertension (systolic and diastolic blood pressures greater than 140 and 90 mm Hg, respectively), but those reporting a history of diabetes at baseline were excluded from the analysis.

The NHS I included 41 193 older women (aged between 30 and 55 years in 1976); the NHS II included 14 151 younger women (aged between 25 and 42 years in 1989); and the HPFS included 19 472 men (aged between 40 and 75 years in 1986). Participants were followed up for 8, 10, and 16 years, respectively.

During follow-up, 3589 cases of diabetes developed. Results were adjusted for several risk factors, including, age, body mass index, physical activity, and the use of other antihypertensive medications.

After adjustment, the relative risk of incident diabetes for those taking a thiazide diuretic compared with those not taking a thiazide was 1.20 (95% confidence interval [CI], 1.08 - 1.33) in older women; 1.45 (95% CI, 1.17 - 1.79) in younger women; and 1.36 (95% CI, 1.17 - 1.58) in men.

Likewise, the risk for incident diabetes was also increased in patients taking beta-blockers relative to those who were not: 1.32 (95% CI, 1.20 - 1.46) in older women and 1.20 (95% CI, 1.05 -1.38) in men. In younger women, a category of "other antihypertensives" was used that included beta-blockers, and their use was associated with an increased risk for 1.46 (95% CI, 1.19 - 1.80).

By contrast, no increase in risk was associated with taking ACE inhibitors or calcium-channel blockers.

According to the researchers, emerging evidence suggests that therapy with ACE inhibitors and angiotensin-receptor blockers, may, in fact, decrease the risk for incident diabetes. They also cited several previous studies indicating mixed results with regard to beta-blockers and diabetes risk.

Diabetes Care. 2006;29:1065-1070

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