Meta-analysis of 94,492 patients with hypertension treated with beta Blockers to determine the risk of new-onset diabetes Mellitus
ABSTRACT 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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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
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ABSTRACT: Hypertension is a powerful risk factor strongly linked to adverse cardiovascular outcomes. Due to its high prevalence health care providers at many levels are involved in treating hypertension. Distinct progress has been made in improving the rates of hypertension awareness and treatment over years but the overall control of hypertension remains inadequate. Several recent guidelines from different sources have been put forward in attempt to bridge the gap between existing evidence and clinical practice. Despite this effort, several misconceptions about treating hypertensive cardiovascular disease continue to persist among clinicians. This review highlights some of the misconceptions regarding antihypertensive therapy. Copyright © 2014 Elsevier Inc. All rights reserved.The American Journal of Medicine 12/2014; 128(5). DOI:10.1016/j.amjmed.2014.11.015 · 5.30 Impact Factor