Cardiovascular therapies and associated glucose homeostasis: implications across the dysglycemia continuum

Abstract

Certain cardiovascular drugs have adverse effects on glucose homeostasis, which may lead to important long-term implications for increased risks of adverse outcomes. Thiazide diuretics, niacin, and beta-adrenergic blockers impair glucose homeostasis. However, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have demonstrated beneficial metabolic effects. The newer vasodilating beta-blocking agents and calcium antagonists appear to be metabolically neutral. These considerations, in addition to meticulous attention to blood pressure control and lifestyle changes, have the potential to beneficially modify glycemia and long-term risks. These considerations have particular importance in younger patients who may also have pre-diabetes or the metabolic syndrome and who are likely to require therapy over the course of decades.

Figure 1. Cardiovascular Disease: Coincidence of Hypertension, CAD, and Diabetes

Inner circles and outer circles represent diagnosed and undiagnosed hypertension, CAD, and diabetes, respectively. Areas and their overlaps are roughly proportional to estimated prevalence of these conditions in the US population. Larger outer area represents incidence of metabolic syndrome, which includes prehypertension, prediabetes, and dyslipidemia. (2,10) CAD = coronary artery disease

Figure 2. Risk of Diabetes by Base- and Added-Strategy Drug Dose in Hypertensive CAD Patients

Reference (hazard ratio 1.0) = atenolol 50 mg/day monotherapy. Data from the International Verapamil SR-Trandolapril Study (INVEST). CAD = coronary artery disease; HCTZ = hydrochlorothiazide

Figure 3. Relationship between Follow-up Systolic BP and Development of Diabetes

Unadjusted relative hazard is shown (triangles) for follow-up systolic BP (mean of measurements before diabetes development or censoring) with reference (hazard ratio 1.0) of 130 mm Hg, the cut-off for metabolic syndrome. With multivariable adjustment this relationship persists (6). Data from the International Verapamil SR-Trandolapril Study (INVEST). BP = blood pressure