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Review
. 2006 Mar 1;22(3):229-33.
doi: 10.1016/s0828-282x(06)70902-3.

Antihypertensive medications and blood sugar: theories and implications

David F Blackburn  1 , Thomas W Wilson
Affiliations
Review

Antihypertensive medications and blood sugar: theories and implications

David F Blackburn et al. Can J Cardiol. .

Abstract
in English, French

Increased rates of diabetes have been reported with thiazide diuretics and beta-blockers, but not with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or calcium channel blockers. These observations are important because significant glycemic effects of drugs may be a source of accelerated cardiovascular risk that is not detectable during restricted clinical trial follow-up periods. The extent to which diabetes is affected by these medications remains unclear, as is the precise mechanism by which diabetes is promoted. However, several plausible theories are presented herein. Although drug-induced diabetes has been a concern for several years, not enough information is available to influence prescribing for the majority of patients. The number one priority should be controlling blood pressure in a timely manner.

Une augmentation des taux de diabète a été signalée avec les diurétiques thiazidiques et les bêta-bloquants, mais non avec les inhibiteurs de l’enzyme de conversion de l’angiotensine, les bloqueurs des récepteurs de l’angiotensine ou les anticalciques. Le phénomène est important puisque les effets glycémiques marqués de ces médicaments peuvent entraîner une exacerbation du risque cardiovasculaire difficilement décelable compte tenu de la brièveté des suivis lors des essais cliniques. On ignore encore quelle est la portée exacte de ces médicaments sur le diabète et par quel mécanisme précis ce dernier serait ainsi favorisé. Par contre, plusieurs théories plausibles sont présentées ici. Bien que le diabète d’origine médicamenteuse suscite déjà l’inquiétude depuis quelques années, les données dont on dispose actuellement sont encore insuffisantes pour que l’on puisse modifier les prescriptions remises à la majorité des patients, l’objectif numéro un du traitement demeurant l’obtention dans les meilleurs délais d’une bonne maîtrise de la tension artérielle.

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Figures

Figure 1)
Figure 1)
Summary of the metabolic abnormalities that contribute to hyperglycemia. Reduced blood flow to tissues, increased hepatic glucose production, impaired insulin secretion, and insulin resistance caused by receptor and postreceptor defects all combine to generate the hyper-glycemic state. Reproduced with permission from The American Diabetes Association (personal communication)
See this image and copyright information in PMC

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