The Clinical Significance of New-Onset Diabetes Mellitus in Hypertension

Abstract

Several intervention trials found that some antihypertensive drugs, mostly ACE inhibitors, calcium-channel blockers and angiotensin II receptor blockers, are associated to a lesser risk of developing diabetes mellitus in comparison with other drug classes, including diuretics and β-blockers. This finding is clinically relevant because it has been demonstrated that patients who develop new-onset diabetes during therapy rapidly become a high-risk population, not dissimilar from patients with prior diagnosis of diabetes. In a recent analysis of the PIUMA (Progetto Ipertensione Umbria Monitoraggio Ambulatoriale) study, pre-treatment glucose levels and use of diuretic drugs were independent predictors of new-onset diabetes. Although there is some controversy on this topic, prevention of new-onset diabetes could contribute to explain at least part of the benefit attributed to ACE inhibitors, calcium-channel blockers and angiotensin II receptor blockers in some intervention trials. In clinical practice, when faced with subjects at high risk of diabetes, it is important to implement nonpharmacological strategies whenever appropriate (diet, physical activity, weight loss). In these subjects, ACE inhibitors, calcium-channel blockers and angiotensin II receptor blockers could be considered first-line drugs.