Comparative Effect of Antihypertensive Therapy on Blood Glucose Level in Hypertensive Patients in an Indian Population

Abstract

Objective:

Hypertensive patients have higher prevalence of insulin resistance and are at increased risk of developing type 2 diabetes mellitus (DM). There is scarcity of data on the relationship between antihypertensive therapies and glycaemic control in Indian population. Thus, the present study was designed to investigate such association among Indian population in a University teaching hospital.

Methods:

The study was carried out on 177 hypertensive patients (with new onset of diabetes or without diabetes) visiting the OPD of medicine department at Majeedia hospital, New Delhi. The drug history of hypertensive patients and blood glucose levels following 1–5 yrs of antihypertensive therapy were recorded.

Results:

The gender distribution of hypertensive patients reveals a higher percentage of incidences in males (53.7%) as compared to females (46.3%). Hypertensive patient without DM on beta blockers and on thiazide shows higher incidence of impaired glucose tolerance (IGT) (17.5%, 18.5%) and DM (10%, 11%) as compared to patient receiving other antihypertensive therapy. While in patients of new onset diabetes the incidence was higher with β-blockers (56.2%) than with thiazides (31.3%) followed by calcium channel blockers (CCBs) (12.5%). There was proportionate increase in incidence with the duration of therapy (3–5 years). None of the patients who were on ACE inhibitors or on angiotensin receptor blockers (ARBs) reported any incidence of IGT or DM.

Conclusion:

To conclude, β-blockers and thiazides increases the risk of type 2 diabetes mellitus with long term antihypertensive therapy requiring regular monitoring. CCBs have lowered risks while ACE inhibitors and ARBs are relatively free of such metabolic adverse effects.

Key words

hypertension - diabetes mellitus - impaired glucose tolerance - beta blockers - ACEIs - thiazide - ARBs - CCBs

• References

• 1 Akiko Y, Mikio A, Machi F et al. The angiotensin II receptor blocker telmisartan improves insulin resistance and has beneficial effects in hypertensive patients with type 2 diabetes and poor glycemic control. Diabetes research and clinical practice A. 2008; 3: 127-131
• 2 Barzilay JI, Pressel S, Davis BR et al. Risk and impact of incident glucose disorder in hypertensive older adults treated with an ACE inhibitor, a diuretic, or a calcium channel blocker: a report from the ALLHAT trial. Am J Hypertens 2004; 17: 1A-1A
• 3 Chaturvedi M, Jindal S, Kumar R. Lifestyle Modification in Hypertension in the Indian Context. JIACM 2009; 10: 46-51
• 4 Cooper-DeHoff RM, Pacanowski MA, Pepine CJ. Cardiovascular Therapies and Associated Glucose Homeostasis. Journal of the American College of Cardiology 2009; 53: 29-35
• 5 Curb JD, Pressel SL, Cutler JA et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group. J Am Med Assoc 1996; 276: 1886-1892
• 6 Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet 2007; 369: 201-207
• 7 Ellison DH, Loffing J. Thiazide Effects and Adverse Effects, Insights From Molecular Genetics. J American Heart Association 2009; 54: 196-202
• 8 Hansson L, Lindholm LH, Niskanen L et al. Effect of angiotensinconverting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999; 353: 611-616
• 9 Huen SC, Goldfarb DS. Adverse Metabolic Side Effects of Thiazides: Implications for Patients with Calcium Nephrolithiasis. American Urological Association 2007; 177: 1238-1245
• 10 Kazumi T, Hozumi T, Ishida Y et al. Effect of nifedipine retard on glucose-induced insulin response in patients with and without Non-insulin-dependent diabetes mellitus and hypertension. Current therapeutic research 1998; 59: 80-91
• 11 Koh KK, Quon MJ, Han SH et al. Distinct vascular and metabolic effects of different classes of anti-hypertensive drugs. International Journal of Cardiology 2008; 20: 30-38
• 12 Kurtz TW, Pravenec M. Antidiabetic mechanisms of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists: beyond the reninangiotensin system. J Hypertension 2004; 22: 2253-2261
• 13 Lindholm LH, Samuelsson O. Clinical relevance of glucose metabolism disturbances induced by antihypertensive drugs. J European Heart 2004; 6: 31-35
• 14 Makita S, Abiko A, Naganuma Y et al. Effects of telmisartan on adiponectin levels and body weight in hypertensive patients with glucose intolerance. Metabolism Clinical and Experimental 2008; 57: 1473-1478
• 15 Niskanen L, Hedner T, Hansson L et al. For the CAPPP Study Group . A subanalysis of the Captopril Prevention Project. Diabetes Care 2001; 24: 543-655
• 16 Pedersen CT, Metra M, Charlesworth A et al. Effects of metoprolol and carvedilol on pre-existing and new onset diabetes in patients with chronic heart failure, data from the Carvedilol Or Metoprolol European Trial (COMET). Heart 2007; 93: 968-973
• 17 Pfeffer MA, Swedberg K, Granger CB et al. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003; 362: 759-766
• 18 Siegel D, Swislocki AL. Effects of Antihypertensives on glucose metabolism. Metabolic Syndrome and Related Disorders 2007; 5: 211-218
• 19 Sowers JR, Bakris GL. Antihypertensive therapy and the risk of type 2 diabetes mellitus. N Engl J Med 2000; 342: 969-970
• 20 Stump CS, Hamilton MT, Sowers JR. Effect of Antihypertensive Agents on the Development of Type 2 Diabetes Mellitus. Mayo Foundation for Medical Education and Research 2006; 81: 796-806
• 21 Wright JM, Musini VM. First-line drugs for hypertension, John Wiley and sons 2009; 32: 232-243
• 22 Yusuf S, Teo K, Anderson C et al. Effects of the angiotensin-receptor blocker telmisartan on cardiovascular events in high-risk patients intolerant to angiotensin-converting enzyme inhibitors: a randomized controlled trial. Lancet 2008; 372: 1174-1183
• 23 Leo N, Thomas H, Lennart H et al. Reduced Cardiovascular Morbidity and Mortality in Hypertensive Diabetic Patients on First-Line Therapy with an ACE Inhibitor Compared with a Diuretic/ß-Blocker–Based Treatment Regimen. Diabetes Care 2001; 24: 2091-2096
• 24 John L. Leahy, Susan Bonner-Weir, Gordon C. Weir. (3-Cell Dysfunction Induced by Chronic Hyperglycemiq. DIABETES CARE 1992; 15: 442-455