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When prediabetes is combined with hypertension, how should antihypertensive drugs be preferred? Studies have shown that ACEi/ARB can bring dual benefits of "diabetes prevention and blood pressure reduction"
A systematic review and meta-analysis published November 13, 2021 in The Lancet (IF: 79.
321) showed that lowering blood pressure, excluding vascular complications known to prevent type 2 diabetes mellitus (T2DM), It can also prevent the onset of diabetes itself
Overall, every 5 mmHg reduction in systolic blood pressure was associated with an 11% reduction in diabetes risk
Figure 1 Antihypertensive treatment and risk of new type 2 diabetes events (systolic blood pressure, per 5mmHg) After an in-depth analysis of drug classes, it was found that different classes of antihypertensive drugs had distinct effects on diabetes risk: ➤ Reducing the risk of T2DM (↓): Renin-angiotensin system (RAS) blockers, namely angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs), reduce the risk of new-onset diabetes by 16%, respectively ; ➤ Increased risk of T2DM (↑): β-blockers, thiazide diuretics increase the risk of diabetes; ➤ No effect (-): Calcium channel blockers
Table 1 Correlation between antihypertensive drug categories and new-onset type 2 diabetes who should be credited, antihypertensive or antihypertensive? Consistent conclusions have not yet been reached
The conclusion observed in this study that "RAS blockers reduce the risk of diabetes" was corroborated in another Mendelian randomized analysis, which found that RAS pathway inhibition similar to ACEi/ARB was found in gene mutants.
The risk of developing diabetes also decreased in the population
However, the researchers believe: "Whether the reduction in diabetes risk is due to the lowering of blood pressure itself or the effect of antihypertensive drugs is not yet conclusive
However, this study fills this evidence gap to a certain extent.
"When prediabetes is combined with hypertension, how should antihypertensive drugs be selected? Regarding the clinical significance of this study, Professor Michael Tanner from NYU Grossman School of Medicine expressed his views based on the current situation in the United States.
The article was recently published in ANNALS OF INTERNAL MEDICINE Journal (IF: 25.
Michael Tanner pointed out that if no life>
Current diabetes prevention methods include life>
The Centers for Disease Control and Prevention estimates that 116 million U.
adults have high blood pressure (systolic blood pressure >130 mmHg or diastolic blood pressure >80 mmHg) and 88 million are prediabetic
reasonable estimate is that currently both have The number of people with hypertension and prediabetes is in the millions
This systematic review and meta-analysis found that in patients treated for hypertension, ACEi and ARBs each reduced the risk of new-onset diabetes by 16%; conversely, thiazides increased the risk of new-onset diabetes Beta-blockers increased the risk of diabetes by 20%, and beta-blockers increased the risk of diabetes by 48%; calcium channel blockers had no effect on the occurrence of diabetes events
Considering the large number of American adults with both hypertension and diabetes Antihypertensive drug therapy in the early stage will undoubtedly bring great benefits
Currently, for the prediabetic population, the guidelines do not recommend which specific classes of antihypertensive drugs should be used, however, the results of this analysis suggest that ACEi or ARB should be used in prediabetic patients.
first-line antihypertensive drugs
References:  Michael Tanner.
Antihypertensive drugs reduced risk for new-onset type 2 diabetes; effect varies by antihypertensive class.
ANNALS OF INTERNAL MEDICINE.
2022 Apr 5.
7326/J22-0018, PMID: 35377716 Nazarzadeh M, Bidel Z, Canoy D, et al.
Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis.