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Antihypertensive Therapy and Incidence of Type 2 Diabetes in an Elderly Cohort

¹ Division of General Internal Medicine, University of Alberta, Edmonton, Alberta
² Institute for Clinical Evaluative Sciences, Toronto, Ontario
³ Faculty of Medicine and Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
⁴ Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario
⁵ Faculty of Medicine, Department of Family and Community Medicine-Family Health Care Research Unit, University of Toronto, Toronto, Ontario
⁶ University Health Network, Toronto Western Hospital, Family Medicine Centre, Toronto, Ontario

Address correspondence and reprint requests to Raj Padwal, Division of General Internal Medicine, University of Alberta Hospital, 2E3.22 Walter C. Mackenzie Health Sciences Center, Edmonton, AB, Canada T6G 2B7. E-mail: rpadwal{at}ualberta.ca

OBJECTIVE—The aim of this study was to determine whether the incidence of type 2 diabetes differed among elderly users of four major antihypertensive drug classes.

RESEARCH DESIGN AND METHODS—This was a retrospective, observational cohort study of previously untreated elderly patients (aged 66 years) identified as new users of an antihypertensive drug class between April 1995 and March 2000. Using a Cox proportional hazards model, the primary analysis compared diabetes incidence in users of ACE inhibitors, ß-blockers, and calcium channel blockers (CCBs), with thiazide diuretics allowed as second-line therapy. In the secondary analysis, thiazide diuretics were added as a fourth study group.

RESULTS—In the multivariable-adjusted primary analysis (n = 76,176), neither ACE inhibitor use (hazard ratio 0.96 [95% CI 0.84–1.1]) nor ß-blocker use (0.86 [0.74–1.0]) was associated with a statistically significant difference in type 2 diabetes incidence compared with the CCB control group. In the secondary analysis (n = 100,653), compared with CCB users, type 2 diabetes incidence was not significantly different between users of ACE inhibitors (0.97 [0.83–1.1]), ß-blockers (0.84 [0.7–1.0]), or thiazide diuretics (1.0 [0.89–1.2]).

CONCLUSIONS—Type 2 diabetes incidence did not significantly differ among users of the major antihypertensive drug classes in this elderly, population-based administrative cohort. These results do not support the theory that different antihypertensive drug classes are relatively more or less likely to cause diabetes.

Abbreviations: CCB, calcium channel blocker • CIHI-DAD, Canadian Institute for Health Information Hospital Discharge Abstract Database • ODB, Ontario Drug Benefit Database • ODD, Ontario Diabetes Database • OHIP, Ontario Health Insurance Plan

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				E. N. Taylor, F. B. Hu, and G. C. Curhan Antihypertensive Medications and the Risk of Incident Type 2 Diabetes Diabetes Care, May 1, 2006; 29(5): 1065 - 1070. [Abstract] [Full Text] [PDF]

				N. N. Chan, P. C.Y. Tong, A. P.S. Kong, W.-b. Chan, and J. C.N. Chan Antihypertensive Therapy and Incidence of Type 2 Diabetes in an Elderly Cohort: Response to Padwal et al. Diabetes Care, March 1, 2005; 28(3): 762 - 762. [Full Text] [PDF]