This discrepancy is the rationale for the very fact that a consensus on the
selection of drug regimen is yet to be reached. There is a clash between the
available guidelines. When the Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation and Treatment of High Blood Pressure
recommended the use of a diuretic in uncomplicated cases of hypertension, the
UK National Institute for Health and Clinical Excellence insists diuretics or beta-blockers
to be used only as third-line or fourth-line agents.
A network meta-analysis was done to compare the association of these drugs with
incident diabetes. Data from 143,153 patients in 22 clinical trials were analysed and
the results were published in Lancet, the leading medical journal
receptor blockers (ARBs) appear to have the lowest risk of precipitating
. Angiotensin converting enzyme (ACE) inhibitors come in
terms of the lowest risk. Third were the calcium channel blockers (CCB).
Beta-blockers and diuretics occupy the fourth and fifth positions respectively.
Thus beta-blockers and
diuretics are associated with increased incidence of diabetes in hypertensive
. Should hypertensive patients become diabetic just because
guidelines advise to use diuretics as first-line drugs? Statistics reveal that
more than 20 million patients are on diuretics and an almost equal number on
beta-blockers. It might partly be the involved economic costs in treating
patients with diabetes that the UK National Institute for Health
and Clinical Excellence recommended diuretics or beta-blockers to be used only
as third-line or fourth-line agents.
Based on the current evidence, the association of antihypertensive drugs with incident
diabetes is thus (from lowest to highest): •
ACE inhibitors •
Diuretics (highest risk)
studies are however required.