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Antihypertensive Medications and the Risk of Incident Type 2 Diabetes

¹ Channing Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
² Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
³ Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

Address correspondence and reprint requests to Eric N. Taylor, MD, Channing Laboratory, Brigham and Women’s Hospital, 181 Longwood Ave., Boston, MA 02115. E-mail: entaylor{at}partners.org

OBJECTIVE—The purpose of this study was to examine the association between the use of different classes of antihypertensive medications and the risk of incident type 2 diabetes.

RESEARCH DESIGN AND METHODS—We conducted a prospective study of three cohorts: the Nurses’ Health Study (NHS) I and II and the Health Professionals Follow-up Study (HPFS). Antihypertensive medication use was ascertained by biennial questionnaires. After excluding participants who reported a history of diabetes at baseline, 41,193 older women (NHS I), 14,151 younger women (NHS II), and 19,472 men (HPFS), all with hypertension, were followed for 8, 10, and 16 years, respectively.

RESULTS—We documented 3,589 incident cases of diabetes. After adjustment for age, BMI, physical activity, the use of other antihypertensive medications, and other risk factors, the multivariate relative risk (RR) of incident diabetes in participants taking a thiazide diuretic compared with those not taking a thiazide was 1.20 (95% CI 1.08–1.33) in older women, 1.45 (1.17–1.79) in younger women, and 1.36 (1.17–1.58) in men. The multivariate RR in participants taking a ß-blocker compared with those not taking a ß-blocker was 1.32 (1.20–1.46) in older women and 1.20 (1.05–1.38) in men. ACE inhibitors and calcium channel blockers were not associated with risk.

CONCLUSIONS—Thiazide diuretic and ß-blocker use were independently associated with a higher risk of incident diabetes. Increased surveillance for diabetes in patients treated with these medications may be warranted.

Abbreviations: ALLHAT, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial • ARIC, Atherosclerosis Risk in Communities • ASCOT, Anglo-Scandinavian Cardiac Outcomes Trial • FFQ, food frequency questionnaire • NHS, Nurses’ Health Study • HPFS, Health Professionals Follow-up Study

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