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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Antihypertensive drugs ranked for diabetes risk

The Lancet has published a paper that set out to rank the different classes of antihypertensives in terms of diabetes risk.

The analysis included 22 studies including 48 treatment arms and comprising 143,153 patients. New onset diabetes risk was ranked for each initial drug class. Diuretics were used as the comparator (risk of 1.0); the other antihypertensive drug classes were calculated as having the following odds ratios:

  • Angiotensin receptor blockers - 0.57 [95% CI 0.46-0.72]
  • Angiotensin converting enzyme inhibitors - 0.67 [95% CI 0.56-0.80]
  • Calcium channel blockers - 0.75 [95% CI 0.62-0.90]
  • Placebo - 0.77 [95% CI 0.63-0.94]
  • Beta-blocker - 0.90 [95% CI 0.75-1.09]

This type of analysis, a network meta-analysis, is a novel technique and the results should be viewed with some caution. Additionally, the analysis has accounted only for initial drug therapy but in many drug trials there are steps where additional antihypertensive drug classes are added into existing treatment until a target blood pressure is reached. The impact of polypharmacy has not been assessed in this analysis.

The article concludes that the risk of new-onset diabetes is lowest with angiotensin receptor blockers and angiotensin converting enzyme inhibitors but does not suggest how the results of this analysis should integrate into current care.

Action: Clinicians should continue to follow the Hypertension Clinical Guideline produced by the National Institute of Health and Clinical Excellence.

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