An In-Depth Study Of Prevalence Of New Onset Type 2 Diabetes Consequent To Use Of Various Anti-Hypertensive Drug Classes

A temporal relation exists between hypertension and diabetes, characterised by presence of several common risk factors. Apart from the causal commonality existing between the two, another aspect that relates the two is the use of antihypertensive drugs (AHDs). Population based data exists in number that shows varied levels of influence of various different classes of AHDs on carbohydrate metabolism, insulin resistance and subsequent risk to develop diabetes. But on the other hand, there are potential limitations that limit the representativeness of these data to population across borders, race, and ethnicity. Severity of illness, restricting characteristics of the included population, differences in prescription and practice patterns, and cost-utility differences, family history of diabetes, lifestyle habits, genetic factors, and fasting insulin and blood glucose levels measurement practices, all may highly influence the risk of diabetes development and all of these may not have been completely controlled in these studies. No AHD drug class has been evaluated in a placebo-controlled trial with diabetes incidence as a blinded, predefined primary endpoint. Also, there are chances that a population which has high baseline risk of developing diabetes may have been directed more to some specific high diabetes risk anti-hypertensive drug classes more often than the rest. Also, alpha-blocker drugs seem to have a significant protection to diabetes. Currently these are not used as first-cut therapy and also not as monotherapy. And due to the fact that these drugs appear late in the algorithmic arrangements of AHDs, chances are that the added risk to the development of diabetes seen with polypharmacy use (2 or more) may not have emerged from their use in these combinations. As most of other AHD therapies increase the risk of developing diabetes, it will be important to address their independent effect on the development of diabetes by suitably controlled randomized trials targeted at suitable population. Also, their use and benefit in polypharmacy with 3 or more drugs should also be looked into.