Thiazide Diuretics Alone or With β-Blockers Impair Glucose Metabolism in Hypertensive Patients With Abdominal Obesity

Abstract

Randomized clinical trials in patients with hypertension and other cardiovascular disease risk factors have shown that antihypertensive therapy with thiazide diuretics and β-blockers is associated with an increased incidence of new-onset diabetes mellitus and other metabolic abnormalities.1,2 There is growing evidence that those patients with central obesity and other components of the cardiometabolic syndrome are especially prone to new-onset diabetes mellitus.1–5 In persons with abdominal obesity, hypertension, and impaired fasting glucose, there is a 3- to 5-fold increase in the risk for incident diabetes mellitus.4 In this context, there is growing evidence of an association between antihypertensive induced new-onset diabetes mellitus and associated increases in cardiovascular disease morbidity and mortality from stroke and myocardial infarction.6 In the present issue of Hypertension ,7 the impact of abdominal obesity on the incidence of adverse metabolic effects accompanying antihypertensive therapy was examined in a population of hypertensive patients treated with atenolol and/or hydrochlorothiazide (HCTZ). A total of 395 middle-age patients, without diabetes mellitus and/or heart disease (considered low-risk hypertensive patients), participating in the Pharmacogenomic Evaluation of Antihypertensive Responses Study, were included. Patients were randomly assigned to HCTZ or atenolol, and the medication was titrated up to the maximum study dose (25 mg of HCTZ or 100 mg of atenolol). Combination therapy with these 2 agents was instituted if target blood pressure <120/70 mm Hg was not achieved with either drug. The mean duration of monotherapy and combination therapy was 6 weeks, respectively. At baseline, abdominal obesity was present in 58% of the study population, and within this …