Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis
Analysis (n=145,939) found reduction of systolic blood pressure by 5 mmHg overall reduced risk of type 2 diabetes (HR 0.89; 95% CI 0.84–0.95). ACE inhibitors and angiotensin II receptor blockers reduced risk but use of beta-blockers and thiazides increased risk.
Source:
The Lancet
SPS commentary:
The authors note the relative magnitude of reduction per 5 mmHg systolic blood pressure lowering was similar to those reported for prevention of major cardiovascular events, which will strengthen the case for blood pressure reduction. Some drug classes had differing effects: when compared to placebo, ACE inhibitors (RR 0.84 [95% 0.76–0.93]) and angiotensin II receptor blockers (0.84; 0.76–0.92]) reduced the risk of new-onset type 2 diabetes, whereas β blockers (1.48; 1.27–1.72) and thiazides (1.20; 1.07–1.35) increased this risk. They suggest this supports decision-making around choice of antihypertensive according to an individual’s risk profile, with ACE inhibitors and angiotensin II receptor blockers the drugs of choice when clinical risk of diabetes is of concern. It is not known to what extent the reduction in diabetes risk is due to blood pressure reduction per se versus RAS inhibition specifically.
An accompanying Comment states the absolute risk reductions observed were modest, however interventions with small benefits can still have large effects when applied to such common conditions. They say the findings of this research support the possibility that earlier, more aggressive lowering of blood pressure, with an emphasis on RAS inhibitors, can decrease the incidence of diabetes.