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 Study Finds Differences between Blood Pressure Medicines and

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PostSubject: Study Finds Differences between Blood Pressure Medicines and   Thu Sep 20, 2007 11:30 pm

Study Finds Differences between Blood Pressure Medicines and Newly-Diagnosed Diabetes



Rush Researchers Identify Antihypertensive Drugs That Facilitate and/or Prevent Diabetes



CHICAGO, IL -- January 19, 2007 --
Patients with high blood
pressure are more likely to develop new-onset diabetes than those who
don't have hypertension, but this tendency is often attributed to
higher weight, recent weight gain, or stronger family history of
diabetes among those with high blood pressure.



Doctors have known since 1958 that some drugs used to control high
blood pressure have the side effect of increasing blood sugar and
causing new-onset diabetes.



Researchers at Rush University Medical Center analyzed the data from
all of the randomized clinical trials (in which the assignment of
initial drugs is based solely on chance, thus balancing the groups
regarding other risk factors for diabetes), and have found significant
differences between antihypertensive drugs. ACE-inhibitors and the
newer angiotensin receptor blockers, or ARBs prevent people from
getting diabetes, and the older diuretics or beta-blockers, increase
the chance that a person becomes diabetic, compared to either placebo
(inactive sugar-pills) or calcium channel blockers according to a study
published in the January 20, 2007 issue of The Lancet.



Rush Preventive Medicine professor Dr. William J. Elliott, and Peter
Meyer, PhD, director of the Section of Biostatistics, analyzed 22
long-term randomized clinical trials of each class of antihypertensive
drugs, including placebo (inactive sugar-pills), to assess the chance
that a person would develop diabetes during about 5 years of
observation. The studies included 143,153 patients, and took place from
1966 through mid-September of 2006.



Their novel method of combining all the information available from
clinical trials found that the lowest risk of new-onset diabetes
occurred with ARBs or ACE-inhibitors, followed by calcium channel
blockers or placebo (both of which were relatively neutral), and
highest with beta-blockers or diuretics. They concluded that compared
to inactive sugar-pills, diuretics or beta-blockers slightly increase
the risk of becoming diabetic, whereas ARBs or ACE-inhibitors
significantly decrease the risk.



"Most other studies of the association between drugs used mostly for
high blood pressure could have been confused by differences in the
patients studied. By only including studies that used randomization to
minimize and balance differences between those assigned to different
antihypertensive drugs, and by using a novel technique that can
attribute risk both between agents that have been directly compared,
and those that compare the results indirectly, we can see differences
that other techniques cannot," said Elliott.



"Our 'indirect comparisons' are similar to the way oddsmakers in Las
Vegas compute the point spread for Sunday's Bears-Saints playoff game.
Since the Bears and Saints haven't played each other (i.e., a direct
comparison) this season, one can compare the record of the Bears
against those teams that the Saints have also played this season. We
use a similar strategy to compare, for example, ACE-inhibitors vs.
ARBs, which have not been compared directly in any clinical trial to
date."



The study is expected to be of greater interest in the United Kingdom
than the United States, because the British National Institute of
Health and Clinical Excellence issued a new set of guidelines about
hypertension treatment for primary care physicians in June 2006 that
are based on economic considerations. Because diabetics generate about
4 times the healthcare expenditures as non-diabetics, the new British
guidelines recommend against using both a diuretic and a beta-blocker
for the routine treatment of hypertension. In the United States,
however, tradition and the 2003 national hypertension guidelines still
recommend a diuretic as first-line treatment, and a beta-blocker only
one of several acceptable second-line options.



The authors were careful to point out that their data do not address
the ongoing controversy about whether new-onset diabetes leads to as
many heart attacks, strokes or death, as long-standing diabetes, which
will require more studies.



The authors' data do suggest, however, that the differences between
antihypertensive drugs regarding the risk for new-onset diabetes are
real and significant. Whether an overweight person with hypertension,
others in the family with diabetes, and a recent weight gain can avoid
the diagnosis of diabetes in the long-term by taking a specific type of
antihypertensive drug is uncertain, and should be discussed with the
treating physician as just one aspect of the choice of drug to lower
blood pressure in that individual.
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