New-onset diabetes and antihypertensive drugs

Observational studies have provided evidence that a consistent fraction (approximately 15-20%) of hypertensive patients displays a glucose intolerance state that may be aggravated by antihypertensive drug regimens based on thiazide diuretics or beta-blockers. This review examines the relative and absolute diabetogenic effects of antihypertensive drugs, by comparing the impact of 'new' (calcium antagonists, angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists) versus 'old' (diuretics and beta-blockers) drugs on new-onset diabetes in recent clinical trials. Evidence is provided that compared with diuretics and beta-blockers, new-onset diabetes is less common with 'new' drugs, and that conventional antihypertensive compounds, particularly when combined together, may amplify the natural time-dependent tendency towards the development of this metabolic disease. This paper provides new insights into the potential mechanisms responsible for the phenomenon and the clinical significance of antihypertensive drug-induced diabetes.