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(Hypertension. 2004;43:941.)
© 2004 American Heart Association, Inc.

Editorial Commentaries

When Does New Onset Diabetes Resulting From Antihypertensive Therapy Increase Cardiovascular Risk

From the Hypertension/Clinical Research Center, Rush University Medical Center (G.L.B.), Chicago, Ill, and University of Missouri-Columbia Health Sciences Center (J.R.S.), Columbia, Mo.

Correspondence to George Bakris, MD, 1700 W. VanBuren St., Suite 470 Chicago, IL 60612. E-mail gbakris@earthlink.net.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The report in this issue of Hypertension by Verdecchia et al,¹ a prospective study in a relatively large group of patients with uncomplicated essential hypertension, demonstrated two important findings. First, baseline level of plasma glucose and use of diuretics after a median follow-up of 6 years were independent predictors for development of new onset diabetes. Second, they observed that the occurrence of a new onset of diabetes in treated hypertensive patients carried a risk for subsequent cardiovascular disease (CVD) events that was not statistically different from those who already had diabetes and hypertension at the onset of the study. Indeed, the risk of CVD events in those with new onset diabetes was not substantially different compared with those who already had diabetes at the onset of the investigation, with both groups having much higher risk than those who remained free of diabetes. These are important and clinically relevant observations.

It is increasingly recognized that persons with hypertension have a high prevalence of insulin resistance and are at substantially higher risk of developing type 2 diabetes mellitus.^2–4 Verdecchia et al’s data support prior observations that certain antihypertensive drug classes (diuretics and ß-blockers) may increase this propensity of patients with hypertension to develop type 2 diabetes.³ Use of diuretics or ß-blockers compared with angiotensin-converting enzyme inhibitors or calcium antagonists was associated with an increased incidence of new diabetes in the Captopril Prevention Project (CAPP)⁵ and the Intervention as a Goal in Hypertension Treatment Study (INSIGHT).⁶ In a prospective study of the Atherosclerosis . . . [Full Text of this Article]

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