Hypertension and risk of development of type 2 diabetes

Nazarzadeh et al performed a one-stage individual participant data meta-analysis, in which data were pooled to investigate the effect of blood pressure lowering per se on the risk of new-onset type 2 diabetes (1)

Results:

• analysis (n=145,939) found reduction of systolic blood pressure by 5 mmHg overall reduced risk of type 2 diabetes (HR 0.89; 95% CI 0.84-0.95)
  
  
• ACE inhibitors and angiotensin II receptor blockers reduced risk but use of beta-blockers and thiazides increased risk
  
  

Conclusions:

• blood pressure lowering is an effective strategy for the prevention of new-onset type 2 diabetes
  • established pharmacological interventions, however, have qualitatively and quantitively different effects on diabetes, likely due to their differing off-target effects, with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers having the most favourable outcomes
  • evidence supports the indication for selected classes of antihypertensive drugs for the prevention of diabetes, which could further refine the selection of drug choice according to an individual's clinical risk of diabetes

Reference:

• Nazarzadeh M et al. Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis. Lancet 2021; 398 (10313): 1803-1810