Comparing six antihypertensive medication classes for preventing new‐onset diabetes mellitus among hypertensive patients: a network meta‐analysis

Abstract

Hypertensive patients usually have a higher risk of new‐onset diabetes mellitus (NOD) which may trigger cardiovascular diseases. In this study, the effectiveness of six antihypertensive agents with respect to NOD prevention in hypertensive patients was assessed. A network meta‐analysis was conducted to compare the efficacy of specific drug classes. PubMed and Embase databases were searched for relevant articles. Results of the pairwised meta‐analysis were illustrated by odd ratios (OR) and a corresponding 95% confidence interval (CI). The probabilities and outcome of each treatment were ranked and summarized using the surface under the cumulative ranking curve (SUCRA).Twenty‐three trials were identified, including 224,832 patients with an average follow‐up period of 3.9 ± 1.0 years. The network meta‐analysis showed that patients treated by angiotensin II receptor blockers (ARBs) were associated with a lower risk of NOD compared to placebo (PCB), calcium channel blockers (CCBs) and β‐blockers, while diuretic appeared to be ineffective for NOD prevention. Network meta‐analysis results of specific drugs showed that enalapril exhibited distinct advantages and hydrochlorothiazide also exhibited a reliable performance. Our results suggested that both ARBs and angiotensin converse enzyme inhibitors (ACEIs), especially candesartan and enalapril, were preferable for NOD prevention in hypertensive patients. Hydrochlorothiazide also exhibited a reliable performance in comparison with other agents.

P3209Calcium channel blocker monotherapy versus combination with renin-angiotensin system blockers in the development of new-onset diabetes mellitus in hypertensive Korean patients

“…Previous studies reported that CCB combined with ARB had metabolically neutral effects [6]. Our study also showed that the use of RASI in addition to CCB did not show a significant reduction of the development of NODM.…”

“…In patients with T2DM, the incidence of CVD is about two- and four-times higher than the general population [5]. Therefore, hypertensive patients have a relatively higher risk of new-onset DM (NODM) and this may trigger further cardiovascular diseases [6]. Antihypertensive drug impacts on the blood glucose level are diverse according to the class of those drugs [7]–[9].…”

Calcium channel blockers as drug repurposing candidates for gestational diabetes: Mining large scale genomic and electronic health records data to repurpose medications

“…Other studies have shown that beta blockers and diuretics are associated with worsening glucose tolerance, CCBs are neutral, and medications which interfere with the renin-angiotensin system are associated with improved glucose tolerance 32 . In a recent network meta-analysis of medications to prevent new-onset diabetes, diuretics were associated with increased risk of new-onset diabetes versus placebo, but beta blockers were not; CCBs were neutral 33 . In in vitro models of insulin secretion, inhibition of L-type calcium channels by nifedipine decreases glucose stimulated insulin secretion from islets, which would correlate with post-prandial hyperglycemia 34 .…”

The place of ramipril in modern guidelines for the management of patients with cardiovascular diseases

“…В сентябре 2017 г. вышел метаанализ, проанализировавший на примере 5 основных классов антигипертензивных средств риск развития новых случаев СД [46]. Было выявлено, что иАПФ и сартаны могут предотвращать развитие новых случаев диабета.…”