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Lin CP, Tung YC, Hsiao FC, Yang CH, Kao YW, Lin YS, Chu YC, Chu PH. Fixed-dose combination of amlodipine and atorvastatin improves clinical outcomes in patients with concomitant hypertension and dyslipidemia. J Clin Hypertens (Greenwich) 2020; 22:1846-1853. [PMID: 32862551 DOI: 10.1111/jch.14016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 01/19/2023]
Abstract
Hypertension and dyslipidemia are important risk factors for cardiovascular disease. However, the clinical outcomes of fixed-dose combination (FDC) versus free-equivalent combination (FEC) of amlodipine and atorvastatin in the treatment of concurrent hypertension and dyslipidemia remain unknown. In this study, we included patients with newly diagnosed hypertension and dyslipidemia, without previously established cardiovascular disease, and treated with either FDC or FEC of amlodipine and atorvastatin were identified from the National Health Insurance Research Database of Taiwan and follow-up for 5 years. By using 1:1 propensity score matching, a total of 1756 patients were enrolled in this study. The composite of major adverse cardiovascular events, including all-cause mortality, myocardial infarction (MI), stroke, and coronary revascularization, occurred more frequently in the FEC group than in the FDC group (hazard ratio, 1.88; 95% confidence interval [CI], 1.42 to 2.5). Although the all-cause mortality did not differ (hazard ratio, 0.46; 95% CI, 0.36 to 1.59), the FEC group developed increased MI, stroke, and coronary revascularization (hazard ratio, 2.87; 95% CI, 1.07 to 7.68; hazard ratio, 1.97; 95% CI, 1.41 to 2.74; and hazard ratio, 2.44; 95% CI, 1.26 to 4.69, respectively). Furthermore, as an unexpected result, a higher risk to develop new-onset diabetes mellitus was observed with FEC regimens (hazard ratio, 2.19; 95% CI, 1.6 to 3.0). In conclusion, although the all-cause mortality did not differ between the two groups, the FDC regimen of amlodipine and atorvastatin improved clinical outcomes when compared to FEC in patients with newly diagnosed hypertension and dyslipidemia.
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Affiliation(s)
- Chia-Pin Lin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Chang Tung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Fu-Chih Hsiao
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hung Yang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Wei Kao
- Big Data Research Center, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei, Taiwan
| | - Yu-Sheng Lin
- Healthcare Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - You-Chia Chu
- Department of Computer Science, National Chiao Tung University, Hsinchu, Taiwan
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Kim YH, Her AY, Rha SW, Choi BG, Choi SY, Byun JK, Kang DO, Jang WY, Kim W, Baek JY, Choi WG, Kang TS, Ahn J, Park SH, Park SH, Hong JY, Park JY, Lee MH, Choi CU, Park CG, Seo HS. Comparison between calcium channel blocker with angiotensin converting enzyme inhibitor or angiotensin II type 1 receptor blocker combination on the development of new-onset diabetes in hypertensive Korean patients. J Diabetes Metab Disord 2020; 19:405-413. [PMID: 32550191 DOI: 10.1007/s40200-020-00521-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
Background and purpose Rare comparative studies investigated the relationship between combination therapy of antihypertensive drugs and the incidence of new-onset diabetes mellitus (NODM). The aim of this study was to evaluate which combination therapy, calcium channel blocker (CCB) with angiotensin converting enzyme inhibitor (ACEI) or CCB with angiotensin II type 1 receptor blocker (ARB), is best in reducing/preventing the development of NODM during 4-year follow-up periods in non-diabetic hypertensive Korean patients. Materials and methods Finally, a total of 1221 consecutive hypertensive patients without a history of diabetes mellitus who had been prescribed CCB were retrospectively enrolled and divided into the two groups, an ACEI group (combination CCB with ACEI, n = 251) and an ARB group (combination CCB with ARB, n = 970). The primary endpoint was NODM, defined as a fasting blood glucose ≥126 mg/dL or hemoglobin A1c ≥ 6.5%. Secondary endpoint was major adverse cardiac events (MACE) defined as total death, non-fatal myocardial infarction (MI) and percutaneous coronary intervention (PCI). Results After propensity-score matched (PSM) analysis, two propensity-matched groups (243 pairs, n = 486, C-statistic = 0.696) were generated. During 4-year follow-up periods, there were similar incidence of NODM (Hazard ratio [HR]; 1.198, 95% confidence interval [CI]; 0.591-2.431, P = 0.616), MACE (HR; 1.324, 95% CI; 0.714-2.453, P = 0.373), total death, MI and PCI between the two groups after PSM analysis. Conclusion CCB with ACE or CCB with ARB combination strategies are equally acceptable in hypertensive Korean patients regarding the occurrence of NODM.
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Affiliation(s)
- Yong Hoon Kim
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Ae-Young Her
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Byoung Geol Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Se Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Jae Kyeong Byun
- Department of Medicine, Korea University Graduate School, Seoul, South Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Won Young Jang
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Ju Yeol Baek
- Cardiovascular Center, Seoul St. Mary's Hospital, the Catholic University of Korea, Seoul, South Korea
| | - Woong Gil Choi
- Cardiology Department, Konkuk University Chungju Hospital, Chungju, South Korea
| | - Tae Soo Kang
- Department of Internal Medicine, Cardiovascular Division, Dankook University Hospital, Cheonan, South Korea
| | - Jihun Ahn
- Department of Cardiology, Soonchunhyang University Gumi Hospital, Gumi, South Korea
| | - Sang-Ho Park
- Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Sung Hun Park
- Department of Internal Medicine, Division of Cardiology, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Ji Yeon Hong
- Department of Internal Medicine, Division of Cardiology, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Ji Young Park
- Department of Internal Medicine, Division of Cardiology, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Min-Ho Lee
- Department of Cardiology, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308 South Korea
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Hall JJ, Eurich DT, Nagy D, Tjosvold L, Gamble JM. Thiazide Diuretic-Induced Change in Fasting Plasma Glucose: a Meta-analysis of Randomized Clinical Trials. J Gen Intern Med 2020; 35:1849-1860. [PMID: 32157653 PMCID: PMC7280437 DOI: 10.1007/s11606-020-05731-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prior meta-analyses measuring thiazide-induced glycemic change have demonstrated an increased risk of incident diabetes; however, this measure's definition has changed over time. AIM To determine the magnitude of change in fasting plasma glucose (FPG) for thiazide diuretics. DATA SOURCES A research librarian designed and conducted searches in Medline®, EMBASE, and EBM Reviews-Cochrane Central Register of Controlled Trials (inception through July 2018) and International Pharmaceutical Abstracts (inception to December 2014). STUDY SELECTION Randomized, controlled trials comparing a thiazide or thiazide-like diuretic to any comparator reporting FPG were identified. Trials enrolling < 50 participants, those with a follow-up period of < 4 weeks, and conference abstracts were excluded. DATA EXTRACTION Independent duplicate screening of citations and full-text articles, data extraction, and assessment of risk of bias was conducted. DATA SYNTHESIS Ninety-five studies were included (N = 76,608 participants), with thiazides compared with placebo, beta-blockers, calcium channel blockers, renin-angiotensin-aldosterone-system inhibitors, potassium-sparing diuretic, and others alone or in combination. Thiazide diuretics marginally increased FPG (weighted mean difference 0.20 mmol/L (95% CI 0.15-0.25); I2 = 84%) (1 mmol/L = 18 mg/dL). Results did not change substantially when considering dose or duration, comparing thiazides with placebo or an active comparator, or using thiazides as monotherapy or combination therapy, even when combined with a potassium-correcting agent. CONCLUSION Thiazide diuretics have a small and clinically unimportant impact on FPG.
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Affiliation(s)
- Jill J. Hall
- Faculty of Pharmacy and Pharmaceutical Sciences, 3-236 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB Canada
| | - Dean T. Eurich
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Danielle Nagy
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
| | - Lisa Tjosvold
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
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Editorial commentary: Metabolic effects of cardiovascular medication: Does it matter? Trends Cardiovasc Med 2019; 29:188-189. [DOI: 10.1016/j.tcm.2018.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/20/2022]
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Ramanathan N, Tan E, Loh LJ, Soh BS, Yap WN. Tocotrienol is a cardioprotective agent against ageing-associated cardiovascular disease and its associated morbidities. Nutr Metab (Lond) 2018; 15:6. [PMID: 29387138 PMCID: PMC5775572 DOI: 10.1186/s12986-018-0244-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/15/2018] [Indexed: 02/07/2023] Open
Abstract
Ageing is a nonmodifiable risk factor that is linked to increased likelihood of cardiovascular morbidities. Whilst many pharmacological interventions currently exist to treat many of these disorders such as statins for hypercholesterolemia or beta-blockers for hypertension, the elderly appear to present a greater likelihood of suffering non-related side effects such as increased risk of developing new onset type 2 diabetes (NODM). In some cases, lower efficacy in the elderly have also been reported. Alternative forms of treatment have been sought to address these issues, and there has been a growing interest in looking at herbal remedies or plant-based natural compounds. Oxidative stress and inflammation are implicated in the manifestation of ageing-related cardiovascular disease. Thus, it is natural that a compound that possesses both antioxidative and anti-inflammatory bioactivities would be considered. This review article examines the potential of tocotrienols, a class of Vitamin E compounds with proven superior antioxidative and anti-inflammatory activity compared to tocopherols (the other class of Vitamin E compounds), in ameliorating ageing-related cardiovascular diseases and its associated morbidities. In particular, the potential of tocotrienols in improving inflammaging, dyslipidemia and mitochondrial dysfunction in ageing-related cardiovascular diseases are discussed.
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Affiliation(s)
- Nardev Ramanathan
- Department of R&D, Davos Life Science Pte Ltd, 3 Biopolis Drive, #04-19, Davos, 138623 Singapore
- Department of R&D, Level 8, Menara KLK 1,Jalan Pju 7/6,Mutiara Damansara, 47810, 47800 Petaling Jaya, Selangor Malaysia
| | - Esther Tan
- Disease Modeling and Therapeutics Laboratory, Institute of Molecular and Cell Biology, 61 Biopolis Drive Proteos, Singapore, 138673 Singapore
| | - Li Jun Loh
- Disease Modeling and Therapeutics Laboratory, Institute of Molecular and Cell Biology, 61 Biopolis Drive Proteos, Singapore, 138673 Singapore
| | - Boon Seng Soh
- Disease Modeling and Therapeutics Laboratory, Institute of Molecular and Cell Biology, 61 Biopolis Drive Proteos, Singapore, 138673 Singapore
- Department of Biological Sciences, National University of Singapore, Singapore, 117543 Singapore
- Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150 China
| | - Wei Ney Yap
- Department of R&D, Davos Life Science Pte Ltd, 3 Biopolis Drive, #04-19, Davos, 138623 Singapore
- Department of R&D, Level 8, Menara KLK 1,Jalan Pju 7/6,Mutiara Damansara, 47810, 47800 Petaling Jaya, Selangor Malaysia
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Das UN. Renin-angiotensin-aldosterone system in insulin resistance and metabolic syndrome. J Transl Int Med 2016; 4:66-72. [PMID: 28191524 DOI: 10.1515/jtim-2016-0022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Obesity and its consequent complications such as hypertension and metabolic syndrome are increasing in incidence in almost all countries. Insulin resistance is common in obesity. Renin- angiotensin system (RAS) is an important target in the treatment of hypertension and drugs that act on RAS improve insulin resistance and decrease the incidence of type 2 diabetes mellitus, explaining the close association between hypertension and type 2 diabetes mellitus. RAS influences food intake by modulating the hypothalamic expression of neuropeptide Y and orexins via AMPK dephosphorylation. Estrogen reduces appetite by its action on the brain in a way similar to leptin, an anorexigenic action that seems to be mediated via hypothalamic pro-opiomelanocortin (POMC) neurons in the arcuate nucleus and synaptic plasticity in the arcuate nucleus similar to leptin. Estrogen stimulates lipoxin A4, a potent vasodilator and platelet anti-aggregator. Since both RAS and estrogen act on the hypothalamic neuropeptides and regulate food intake and obesity, it is likely that RAS modulates LXA4 synthesis. Thus, it is proposed that Angiotensin-II receptor blockers and angiotensin-converting enzymes and angiotensin-II antagonists may have the ability to augment LXA4 synthesis and thus bring about their beneficial actions.
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Noto H, Goto A, Tsujimoto T, Noda M. Effect of calcium channel blockers on incidence of diabetes: a meta-analysis. Diabetes Metab Syndr Obes 2013; 6:257-61. [PMID: 23935375 PMCID: PMC3735278 DOI: 10.2147/dmso.s49767] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS Insulin resistance and the progressive loss of β-cell function are components of the fundamental pathophysiology of type II diabetes. A recent experimental study suggested that calcium channel blockers (CCBs) might inhibit β-cell apoptosis, enhance β-cell function, and prevent diabetes. The present meta-analysis examined the clinical effect of CCBs on the incidence of diabetes. METHODS MEDLINE, EMBASE, ISI Web of Science, the Cochrane Library, and ClinicalTrials. gov were each searched for relevant articles published up to March 11, 2013. Randomized controlled trials (RCTs) with a follow-up period of at least 1-year were included. Identified articles were systematically reviewed, and those with pertinent data were selected for inclusion in a meta-analysis. RESULTS We included ten RCTs in a meta-analysis. Of the 108,118 people with hypertension and no pre-existing diabetes, 7,073 (6.5%) cases of type II diabetes were reported. CCBs were associated with a higher incidence of diabetes than angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs; pooled risk ratios [95% confidence intervals]: 1.23 [1.01-1.51] and 1.27 [1.14-1.42], respectively) and a lower incidence compared with β blockers or diuretics (0.83 [0.73-0.94] and 0.82 [0.69-0.98], respectively). The overall risk of diabetes among subjects taking CCBs was not significant (0.99 [0.85-1.15]). CONCLUSION THE USE OF CCBS WAS NOT SIGNIFICANTLY ASSOCIATED WITH INCIDENT DIABETES COMPARED TO OTHER ANTIHYPERTENSIVE AGENTS: the association with diabetes was lowest for ACEIs and ARBs, followed by CCBs, β blockers, and diuretics. Although CCBs can be safely used in hypertensive patients, it would be premature to advocate CCBs for the prevention or treatment of diabetes.
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Affiliation(s)
- Hiroshi Noto
- Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
- Correspondence: Hiroshi Noto, Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan, Tel +81 3 3202 7181, Fax +81 3 3207 1038, Email
| | - Atsushi Goto
- Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tetsuro Tsujimoto
- Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
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Geng DF, Jin DM, Wu W, Liang YD, Wang JF. Angiotensin converting enzyme inhibitors for prevention of new-onset type 2 diabetes mellitus: a meta-analysis of 72,128 patients. Int J Cardiol 2012; 167:2605-10. [PMID: 22809536 DOI: 10.1016/j.ijcard.2012.06.125] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/23/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Angiotensin converting enzyme inhibitors (ACEIs) have been linked to reduced risk of new-onset diabetes, but the evidence was insufficient. OBJECTIVE AND METHODS The aim of this study was to evaluate the effect of ACEIs on the development of new-onset type 2 diabetes. Randomized controlled trials (RCTs) about ACEIs and new-onset diabetes were identified by electronic and manual searches. RESULTS Nine RCTs with 92,404 patients (72,128 non-diabetic patients at baseline) were included in this study. Compared with control group, incidence of new-onset diabetes was significantly reduced in the ACEIs group [OR 0.80, (0.71, 0.91)], irrespective of achieved blood pressure levels at the follow-up. ACEIs therapy was associated with significant reduction in the risk of new-onset diabetes compared with beta-blockers/diuretics [OR 0.78, (0.65, 0.93)], placebo [OR 0.79, (0.64, 0.96)], or calcium channel blockers [OR 0.85, (0.73, 0.99)]. ACEIs treatment was associated with significant reduction in the risk of new-onset diabetes in patients with hypertension [OR 0.80, (0.68, 0.93)], coronary artery disease (CAD) or cardiovascular disease [OR 0.83, (0.68, 1.00)], or heart failure [OR 0.22, (0.10, 0.47)]. Among patients with impaired glucose tolerance or impaired fasting glucose, ramipril did not significantly reduce the incidence of diabetes [OR 0.91, (0.79, 1.05)], but significantly increased regression to normoglycemia. CONCLUSION ACEIs have beneficial effects in preventing new-onset diabetes. ACEIs provide additional benefits of lowering the risk of new-onset diabetes in patients with hypertension, CAD or other cardiovascular disease.
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Affiliation(s)
- Deng-feng Geng
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510120 Guangzhou, China
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Geng DF, Jin DM, Wu W, Xu Y, Wang JF. Angiotensin receptor blockers for prevention of new-onset type 2 diabetes: a meta-analysis of 59,862 patients. Int J Cardiol 2010; 155:236-42. [PMID: 21036409 DOI: 10.1016/j.ijcard.2010.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Accepted: 10/02/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND Angiotensin receptor blockers (ARBs) have been linked to reduced risk of new-onset diabetes, but the evidence was insufficient. OBJECTIVE AND METHODS The aim of this study was to evaluate the effect of ARBs on the development of new-onset type 2 diabetes. Randomized controlled trials (RCTs) about ARBs and new-onset diabetes were identified by electronic and manual searches. RESULTS Eleven RCTs with 79,773 patients (59,862 non-diabetic patients at baseline) were included in this study. Compared with control group, incidence of new-onset diabetes was significantly reduced in ARBs group [OR 0.79, (0.74, 0.84)] and various categories of ARBs subgroup. ARBs were associated with significant reduction in the risk of new-onset diabetes compared with placebo [OR 0.83, (0.78, 0.89)], beta-blocker [OR 0.73, (0.62, 0.87)], calcium channel blocker [OR 0.76, (0.68, 0.85)] and non-ARB [OR 0.57, (0.36, 0.91)]. ARBs were associated with significant reduction in the risk of new-onset diabetes in patients with hypertension [OR 0.74, (0.68, 0.81)], heart failure [OR 0.70, (0.50, 0.96)], impaired glucose tolerance [OR 0.85, (0.78, 0.92)] or cardiocerebrovascular diseases [OR 0.84, (0.72, 0.97)]. Compared with control group, incidence of new-onset diabetes was significantly reduced in ARBs group, irrespective of achieved blood pressure level. ARBs were associated with a lower incidence of new-onset diabetes in Western population [OR 0.81, (0.76, 0.85)] and Japanese population [OR 0.61, (0.48, 0.79)]. CONCLUSION There is sufficient evidence that ARBs have beneficial effect in preventing new-onset type 2 diabetes. ARBs should be considered in patients with high risk of developing diabetes.
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Affiliation(s)
- Deng-feng Geng
- Department of Cardiology, Sun Yat-sen memorial hospital, Zhongshan University, 510120 Guangzhou, China
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10
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Abstract
Obesity is a major risk factor for the development of diabetes and predisposes individuals to hypertension and dyslipidaemia. Together these pathologies increase the risk for cardiovascular disease (CVD), the major cause of morbidity and mortality in type 2 diabetes mellitus (T2DM). Worsening trends in obesity and T2DM raise a serious conundrum, namely, how to control blood glucose, blood pressure, and lipids when many antidiabetic agents cause weight gain and thereby exacerbate other cardiovascular risk factors associated with T2DM. Further, evidence suggests that some established antihypertensive agents may worsen glucose intolerance. Many patients who are obese, hypertensive, and/or hyperlipidaemic fail to achieve blood pressure, lipid and glycaemic goals, and this failure may in part be explained by physician reluctance to utilize complex combination regimens for fear of off-target effects. Thus, a clear need exists for clinicians to understand the risks and benefits of different pharmacologic, and indeed non-pharmacologic, options in order to maximize treatment outcomes. While intensive lifestyle modification remains an elusive gold standard, newer diabetes targets, including the incretin axis, may offer greater cardiovascular risk reduction than other antidiabetes therapies, although definitive clinical trial data are needed. The glucagon-like peptide-1 (GLP-1) receptor agonists exenatide and liraglutide and the dipeptidyl peptidase-4 (DPP-4) inhibitors sitagliptin and vildagliptin effectively lower HbA1c; exenatide and liraglutide reduce weight and blood pressure and improve lipid profiles. Sitagliptin and vildagliptin are weight neutral but also appear to improve lipid profiles. Integration of incretin therapies into the therapeutic armamentarium is a promising approach to improving outcomes in T2DM, and perhaps even in reducing complications of T2DM, such as co-morbid hypertension and dyslipidaemia. Additional long-term studies, including CVD end-point studies, will be necessary to determine the appropriate places for incretin-based therapies in treatment algorithms.
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Affiliation(s)
- Kevin Niswender
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Tennessee Valley Healthcare System and Vanderbilt University School of Medicine, Nashville, TN, USA.
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IIJIMA H, OSUMI T, KOSHIMIZU T. Development and Analyses of Evaluation Criteria for Meta-analysis-Relationship between Renin-Angiotensin System Inhibitor and Diabetes Mellitus-. YAKUGAKU ZASSHI 2010; 130:1215-23. [DOI: 10.1248/yakushi.130.1215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Hisashi IIJIMA
- Drug Information Center, Chiba Pharmaceutical Association
| | - Tomoka OSUMI
- Drug Information Center, Chiba Pharmaceutical Association
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Various populations with hypertension have been singled out by current treatment guidelines as requiring more specific treatment. These include patients with stage 2 hypertension, black patients, and patients with coexistent diabetes mellitus and coronary heart disease. Hypertension in these groups is often associated with higher risk of cardiovascular morbidity and mortality. This article reviews current knowledge regarding hypertension in high-risk patient populations, with a particular focus on the importance of prompt, aggressive treatment to lower blood pressure and prevent cardiovascular disease progression. Such treatment includes the early use of multiple-drug therapy with agents that have complementary blood pressure-lowering mechanisms and provide protection from target organ damage. While 2- or 3-drug antihypertensive therapy in these high-risk groups has typically included a diuretic, other combinations of agents may be indicated. Evidence suggests that therapy with a calcium channel blocker and an inhibitor of the renin-angiotensin system is one effective strategy for lowering blood pressure and improving outcomes in these populations.
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Affiliation(s)
- Kenneth A Jamerson
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Health Care System, Ann Arbor, MI 48109, USA.
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