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

  1. Raj Padwal, MD1,
  2. Muhammad Mamdani, PHARMD23,
  3. David A. Alter, MD234,
  4. Jan E. Hux, MD234,
  5. Deanna M. Rothwell, MSC3,
  6. Karen Tu, MD256 and
  7. Andreas Laupacis, MD234
  1. 1Division of General Internal Medicine, University of Alberta, Edmonton, Alberta
  2. 2Institute for Clinical Evaluative Sciences, Toronto, Ontario
  3. 3Faculty of Medicine and Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
  4. 4Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario
  5. 5Faculty of Medicine, Department of Family and Community Medicine-Family Health Care Research Unit, University of Toronto, Toronto, Ontario
  6. 6University Health Network, Toronto Western Hospital, Family Medicine Centre, Toronto, Ontario
  1. 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.

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.
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  1. doi: 10.2337/diacare.27.10.2458 Diabetes Care October 2004 vol. 27 no. 10 2458-2463
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