A Meta-Analysis of 94,492 Patients With Hypertension Treated With Beta Blockers to Determine the Risk of New-Onset Diabetes Mellitus

Sheba Medical Center, Gan, Tel Aviv, Israel
The American Journal of Cardiology (Impact Factor: 3.28). 10/2007; 100(8):1254-62. DOI: 10.1016/j.amjcard.2007.05.057
Source: PubMed


Beta blockers used for the treatment of hypertension may be associated with increased risk for new-onset diabetes mellitus (DM). A search of Medline, PubMed, and EMBASE was conducted for randomized controlled trials of patients taking beta blockers as first-line therapy for hypertension with data on new-onset DM and follow-up for > or =1 year. Twelve studies evaluating 94,492 patients fulfilled the inclusion criteria. Beta-blocker therapy resulted in a 22% increased risk for new-onset DM (relative risk 1.22, 95% confidence interval [CI] 1.12 to 1.33) compared with nondiuretic antihypertensive agents. A higher baseline fasting glucose level (odds ratio [OR] 1.01, 95% CI 1.00 to 1.02, p = 0.004) and greater systolic (OR 1.05, 95% CI 1.05 to 1.08, p = 0.001) and diastolic (OR 1.06, 95% CI 1.01 to 1.10, p = 0.011) blood pressure differences between the 2 treatment modalities were significant univariate predictors of new-onset DM. Multivariate meta-regression analysis showed that a higher baseline body mass index (OR 1.17, 95% CI 1.01 to 1.33, p = 0.034) was a significant predictor of new-onset DM. The risk for DM was greater with atenolol, in the elderly, and in studies in which beta blockers were less efficacious antihypertensive agents and increased exponentially with increased duration on beta blockers. For the secondary end points, beta blockers resulted in a 15% increased risk for stroke, with no benefit for the end point of death or myocardial infarction. In conclusion, beta blockers are associated with an increased risk for new-onset DM, with no benefit for the end point of death or myocardial infarction and with a 15% increased risk for stroke compared with other agents. This risk was greater in patients with higher baseline body mass indexes and higher baseline fasting glucose levels and in studies in which beta blockers were less efficacious antihypertensive agents compared with other treatments.

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    • "Számos probléma merült fel ezzel kapcsolatban. Például Bangalore és munkatársai 2007-ben egy 94 000 fős metaanalízisben a hagyományos β-blokkoló kezelés mellett újonnan kialakuló diabetes mellitus arányát összehasonlították az egyéb vérnyomáscsökkentő kezelés mellett tapasztalható esetekkel [6]. Azt tapasztalták, hogy β-blokkoló kezelés mellett 22%-kal, szignifikáns mértékben gyakoribb volt a 2-es típusú diabetes kialakulása az egyéb, nem diureti kum alapú antihipertenzív kezeléssel szemben. "
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    ABSTRACT: The choice of treatment of patients with hypertension should not be based solely on the blood pressure value, because the risk of cardiovascular diseases are influenced by the presence and magnitude of other risk factors, too. The presence of a metabolic disease (diabetes mellitus, metabolic syndrome) itself categorizes the patient as a high risk individual. In such cases the use of combined treatment is usually considered. For example, in case of hypertension aggraviated by left ventricular dysfunction, ischaemic heart disease or cardiac insufficiency, β-blocker treatment is usually included in the combination of the first setting. Orv. Hetil., 2015, 156(16), 623-625.
    Orvosi Hetilap 04/2015; 156(16):623-625. DOI:10.1556/OH.2015.30146
    • "The decline was time-related to the introduction of the 2006 NICE guidelines [35]. In addition to guidelines, general practitioners aware of some evidence that beta blockers may be less effective at reducing blood pressure [40], as well as of their association with new onset diabetes [41] may contribute to the constant reduction in BB use over the period. However opposite trends in BB prescribing have also been observed. "
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    ABSTRACT: In England, the National Institute for Health and Care Excellence (NICE) produces guidelines for the management of hypertension. In 2006, the NICE guidelines introduced an ethnic-age group algorithm based on the 2004 British Hypertension Society guidelines to guide antihypertensive drug prescription. A longitudinal retrospective study with 15933 hypertensive patients aged 18 years or over and registered with 28 general practices in Wandsworth, London in 2007 was conducted to assess variations in antihypertensive prescribing. Logistic models were used to measure variations in the odds of being prescribed the 2006 NICE first line recommended monotherapy among NICE patient groups over the period. From 2000 to 2007, the percentage of patients prescribed the recommended monotherapy increased from 54.2% to 61.4% (p < 0.0001 for annual trend). Over the study period, black patients were more likely to be prescribed the recommended monotherapy than younger non-black patients (OR 0.16, 95% CI 0.12 - 0.21) and older non-black patients (OR 0.49, 95% CI 0.37 - 0.65). After the introduction of the NICE guidelines there was an increase in the NICE recommended monotherapy (OR 1.44, 95% CI 1.19 - 1.75) compared with the underlying trend. Compared to black patients, an increase in the use of recommended monotherapy was observed in younger non-black patients (OR 1.49, 95% CI 1.17 - 1.91) but not in older non-black patients (OR 0.58, 95% CI 0.46 - 0.74). The introduction of the 2006 NICE guideline had the greatest impact on prescribing for younger non-black patients. Lower associated increases among black patients may be due to their higher levels of recommended prescribing at baseline. The analysis suggests that guidelines did not impact equally on all patient groups.
    BMC Health Services Research 02/2014; 14(1):87. DOI:10.1186/1472-6963-14-87 · 1.71 Impact Factor
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    • "Although the small sample size could have limited the ability to detect between class differences in BP lowering, beta-blocker and diuretic therapy did reduce nighttime BP more than the other agents. Unfortunately, this poses a problem because both beta-blockers and diuretics have been associated with increased risk of new onset diabetes,96,97 with beta-blocker therapy being associated with a greater incidence of cardiovascular morbidity and mortality.98 There is, however, some encouraging new data suggesting that antihypertensive treatment with a mineralocorticoid receptor antagonist in OSA patients with resistant hypertension substantially improves both BP and OSA severity.99 "
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    ABSTRACT: Obstructive sleep apnea (OSA) is increasingly being recognized as a major health burden with strong focus on the associated cardiovascular risk. Studies from the last two decades have provided strong evidence for a causal role of OSA in the development of systemic hypertension. The acute physiological changes that occur during apnea promote nocturnal hypertension and may lead to the development of sustained daytime hypertension via the pathways of sympathetic activation, inflammation, oxidative stress, and endothelial dysfunction. This review will focus on the acute hemodynamic disturbances and associated intermittent hypoxia that characterize OSA and the potential pathophysiological mechanisms responsible for the development of hypertension in OSA. In addition the epidemiology of OSA and hypertension, as well as the role of treatment of OSA, in improving blood pressure control will be examined.
    Nature and Science of Sleep 05/2013; 5:43-52. DOI:10.2147/NSS.S34841
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