Antihypertensive Therapy and Incidence of Type 2 Diabetes in an Elderly Cohort
- Raj Padwal, MD1,
- Muhammad Mamdani, PHARMD23,
- David A. Alter, MD234,
- Jan E. Hux, MD234,
- Deanna M. Rothwell, MSC3,
- Karen Tu, MD256 and
- Andreas Laupacis, MD234
- 1Division of General Internal Medicine, University of Alberta, Edmonton, Alberta
- 2Institute for Clinical Evaluative Sciences, Toronto, Ontario
- 3Faculty of Medicine and Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
- 4Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario
- 5Faculty of Medicine, Department of Family and Community Medicine-Family Health Care Research Unit, University of Toronto, Toronto, Ontario
- 6University 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
Abstract
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, β-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 β-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]), β-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.
- 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
Footnotes
-
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
-
- Accepted July 9, 2004.
- Received April 29, 2004.
- DIABETES CARE
