Key result
Thiazide-based antihypertensive regimens were not associated with an increased risk of new-onset diabetes compared with ACEI-based regimens (HR 1.540; 95% CI 0.963-2.463).
Why the study?
Antihypertensive drugs have been associated with new-onset diabetes in many countries, but this relationship had not been studied in Thai patients with hypertension.
Does a thiazide-based or combined antihypertensive regimen increase the risk of new-onset diabetes compared to an ACEI-based regimen in newly diagnosed hypertensive patients?
Cohort (n=3,689)
Yes
Does a thiazide-based or combined antihypertensive regimen increase the risk of new-onset diabetes compared to an ACEI-based regimen in newly diagnosed hypertensive patients?
Hazard Ratio: 1.54 (95% CI 0.963–2.463)
Absolute Event Rate: 14.17% vs 11.06%
In Thai Isan patients, thiazide-based and combined antihypertensive regimens were not significantly associated with an increased risk of new-onset diabetes compared to ACEI-based regimens.
Supports no excess diabetes risk with thiazides versus ACEIs; leaves open need for randomized confirmation.
Diabetes is a major global public health problem worldwide caused by many factors including genetics and medication. Antihypertensive drugs had been reported to be associated with new-onset diabetes (NOD) in many countries, but not in Thai patients with hypertension. The purpose of this study was to investigate the association between antihypertensive drugs and NOD among Thai Isan patients. This retrospective cohort study obtained data from electronic medical records from community hospitals in Ubon Ratchathani from January 1, 2007 through December 31, 2015. Newly diagnosed hypertensive patients aged 20 years who received ACEI-based, thiazide-based and combined regimen were identified by ICD 10 code (I10 -I15) and were followed up for 6 years or diagnosed with NOD (E10 -E14). Propensity score was used as a covariate to control for confounding by indication bias due to non-randomly selection process during routine clinical treatment of hypertensive patients. Kaplan-Meier analysis and multivariate cox regression with propensity score adjustment were used to investigate the incidence and the risk of NOD. Of 3,689 newly diagnosed hypertension patients enrolled, 396 (10.73% ) patients developed NOD during follow-up period. NOD incidence were 11.06 (95%CI, 9.19 -13.27), 14.17 (95%CI, 12.48 -16.05), and 14.17 (95%CI, 11.53 -17.35) in ACEI-based, thiazide-based and combined regimen users respectively. After adjusting for confounding by indication, the Hazard Ratios were 1.540 (95%CI, 0.963 -2.463) for thiazide-based regimen and 1.341 (95% CI, 0.769-2.338) for combined regimen compared to ACEIbased regimen. In conclusion, thiazide-based and combined regimen were not associated with NOD compared with ACEI-based regimen in Thai Isan patients.
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Chalermrum et al. (2020) conducted a cohort in Hypertension (n=3,689). Thiazide-based regimen vs. ACEI-based regimen was evaluated on New-onset diabetes (NOD) (HR 1.540, 95% CI 0.963-2.463). Thiazide-based antihypertensive regimens were not associated with an increased risk of new-onset diabetes compared with ACEI-based regimens (HR 1.540; 95% CI 0.963-2.463).
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