When prediabetes is combined with hypertension, how should antihypertensive drugs be selected? Studies have shown that ACEi/ARB can bring dual benefits of “ diabetes prevention + blood pressure reduction”.
November 13, 2021, a systematic review and meta-analysis published in The Lancet (IF: 79.321): Lower blood pressure, except for known In addition to preventing the vascular complications of type 2 diabetes (T2DM), it can also prevent the onset of diabetes itself. Overall, every 5 mmHg reduction in systolic blood pressure was associated with an 11% reduction in diabetes risk. Figure 1 Antihypertensive therapy and new incident type 2 diabetes Risk (systolic blood pressure, per 5mmHg)An in-depth analysis of the drug classes found that different classes of antihypertensive drugs have different effects on diabetes risk Impact:
➤Reduce T2DM risk (↓):< /strong>Renin-angiotensin system (RAS) blockers, namely angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs), respectivelyreduce the risk of new-onset diabetes 16%;➤Increased risk of T2DM (↑): β-blockers, Thiazine Diuretics increase diabetes risk;➤No effect (-): Calcium channel blockers.
table 1 Association of antihypertensive drug classes with new-onset type 2 diabetes
Who should get credit for, blood pressure or blood pressure medication?
Consistency has not been concluded.
The conclusion that RAS blockers reduce the risk of diabetes observed in this study was found in another Mendelian randomized study. The analysis was corroborated by the discovery that people with RAS pathway inhibition similar to ACEi/ARB in the gene mutation also had a reduced risk of diabetes.
However, the researchers believe: “Whether the reduction in diabetes risk is due to the reduction in blood pressure itself or the effect of antihypertensive drugs is not yet conclusive. However, This study fills this evidence gap to some extent.”
< p>How to choose antihypertensive drugs when prediabetes is complicated with hypertension? On the study Prof. Michael Tanner from New York University Grossman School of Medicine expressed his views in light of the current situation in the United States. The article was recently published in the journal ANNALS OF INTERNAL MEDICINE (IF: 25.391).
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Professor Michael Tanner pointed out that if you do not change your lifestyle, you are already in pre-diabetes 15% to 30% of nearly 100 million Americans (HbA1c, 5.7% to 6.4%) will develop diabetes within 3 to 5 years; this means that about 20 million people will be at risk from diabetes in the future . Current diabetes prevention methods include lifestyle changes and the use of metformin, and it would be gratifying if other programs could be supplemented on this basis.The Centers for Disease Control and Prevention estimates that 116 million U.S. adults have high blood pressure (systolic >130mmHg or diastolic >80mmHg), 88 million in pre-diabetes. It is reasonable to estimate that there are currently millions of people living with both high blood pressure and prediabetes. This systematic review and meta-analysis found that ACEi and ARB, respectively, reduced the risk of new-onset diabetes in patients treated for hypertension In contrast, thiazides increased the risk of diabetes by 20%, beta-blockers increased the risk of diabetes by 48%; calcium channel blockers had no effect on the occurrence of diabetes events.Considering the large number of American adults with both hypertension and prediabetes, antihypertensive drug therapy would undoubtedly be of great benefit. Currently, guidelines do not recommend which specific classes of antihypertensive drugs should be used for the prediabetic population, however, the results of this analysis suggest that ACEi or ARBs should be used as first-line antihypertensive drugs in prediabetic patients. References:
[1]Michael Tanner.Antihypertensive drugs reduced risk for new-onset type 2 diabetes; effect varies by antihypertensive class. ANNALS OF INTERNAL MEDICINE. 2022 Apr 5. DOI: 10.7326/J22-0018, PMID: 35377716
[2]Nazarzadeh M, Bidel Z, Canoy D, et al. Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis. Lancet. 2021;398:1803-10.