Effect of antihypertensive agents on the development of type 2 diabetes mellitus

Craig S. Stump, Marc T. Hamilton, James R. Sowers

Research output: Contribution to journalReview article

51 Scopus citations

Abstract

People with hypertension have a high prevalence of insulin resistance and are at relatively high risk of developing type 2 diabetes mellitus. It is becoming increasingly evident that antihypertensive agents have disparate metabolic effects. For example, recent clinical trials indicate that agents that interrupt the renin-angiotensin axis reduce the risk of developing diabetes compared with other classes of antihypertensive agents. Blockade of the effects of angiotensin II might improve blood flow to insulin-sensitive tissues. Furthermore, interruption of the renin-angiotensin system might provide metabolic benefit through such mechanisms as reduced oxidative stress and restored nitric oxide production, which could lead to improved insulin signaling. Alternatively, collective trials suggest that both diuretics and β-blockers accelerate the appearance of new-onset type 2 diabetes mellitus in patients with hypertension. Therefore, the risk of new-onset diabetes-associated cardiovascular risks should be factored into future treatment recommendations for patients who require antihypertensive therapy. This will become even more important as the number of insulin-resistant patients with hypertension increases in parallel with the steady growth in the number of sedentary, obese, and aged persons in our population.

Original languageEnglish (US)
Pages (from-to)796-806
Number of pages11
JournalMayo Clinic Proceedings
Volume81
Issue number6
DOIs
StatePublished - Jun 2006

Keywords

  • ACE = angiotensin-converting enzyme
  • ALLHAT = Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attacks Trial
  • ARB = angiotensin receptor blocker
  • CCB = calcium channel blocker

ASJC Scopus subject areas

  • Medicine(all)

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