Tom Nolan’s research reviews—26 November 2021

#### Thiazides and β blockers feel the pressure “5 mm Hg, 11%.” I’m trying to commit these numbers to memory for consultations with patients at high risk of developing diabetes: lowering your systolic blood pressure by five points reduces the chances of getting diabetes by about a tenth. This was one of the conclusions of a meta-analysis of individual participant data from 22 studies conducted between 1973 and 2008.1 The study also found that ACE inhibitors and angiotensin II receptor blockers reduce the risk of developing diabetes (relative risk of 0.84 for both drug classes), whereas thiazide diuretics and β blockers increase the risk (relative risks of 1.2 and 1.48 respectively). Calcium channel blockers, which have always seemed such stoical drugs, sit in the middle refusing to get involved (relative risk 1.02). So we now have another factor to throw into the pot when discussing the choice of antihypertensive with patients. Although age and ethnicity are central to NICE recommendations on choice of antihypertensive, these weren’t discussed in this paper. …