Fasting glucose levels and incident diabetes mellitus in older nondiabetic adults randomized to receive 3 different classes of antihypertensive treatment - A report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

被引:187
作者
Barzilay, Joshua I.
Davis, Barry R.
Cutler, Jeffrey A.
Pressel, Sara L.
Whelton, Paul K.
Basile, Jan
Margolis, Karen L.
Ong, Stephen T.
Sadler, Laurie S.
Summerson, John
机构
[1] Univ Texas, Sch Publ Hlth, Coordinating Ctr Clin Trials, Houston, TX 77030 USA
[2] Emory Univ, Sch Med, Kaiser Permanente, Atlanta, GA 30322 USA
[3] Emory Univ, Sch Med, Div Endocrinol, Atlanta, GA 30322 USA
[4] NHLBI, Div Epidemiol & Clin Applicat, Bethesda, MD 20892 USA
[5] Tulane Univ, Hlth Sci Ctr, New Orleans, LA 70118 USA
[6] Med Univ S Carolina, Ralph H Johnson Vet Affairs Med Ctr, Charleston, SC 29425 USA
[7] Hennepin Cty Med Ctr, Div Clin Epidemiol, Minneapolis, MN 55415 USA
[8] Ong Med Ctr, Oxon Hill, MD USA
[9] St Vincent Char Hosp & Hlth Ctr, Lipid Res Ctr, Cleveland, OH USA
[10] Wake Forest Univ, Sch Med, Dept Publ Hlth Sci, Winston Salem, NC 27109 USA
关键词
D O I
10.1001/archinte.166.20.2191
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Elevated blood glucose levels are reported with thiazide-type diuretic treatment of hypertension. The significance of this finding is uncertain. Our objectives were to compare the effect of first-step antihypertensive drug therapy with thiazide-type diuretic, calcium-channel blocker, or angiotensin-converting enzyme inhibitor on fasting glucose (FG) levels and to determine cardiovascular and renal disease risks associated with elevated FG levels and incident diabetes mellitus (DM) in 3 treatment groups. Methods: We performed post hoc subgroup analyses from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) among nondiabetic participants who were randomized to receive treatment with chlorthalidone (n= 8419), amlodipine (n= 4958), or lisinopril ( n= 5034) and observed for a mean of 4.9 years. Results: Mean FG levels increased during follow-up in all treatment groups. At year 2, those randomized to the chlorthalidone group had the greatest increase ( + 8.5 mg/dL [0.47 mmol/L] vs + 5.5 mg/dL [0.31 mmol/L] for amlodipine and + 3.5 mg/dL [0.19 mmol/L] for lisinopril). The odds ratios for developing DM with lisinopril (0.55 [95% confidence interval, 0.43-0.70]) or amlodipine (0.73 [ 95% confidence interval, 0.58-0.91]) vs chlorthalidone at 2 years were significantly lower than 1.0 (P <. 01). There was no significant association of FG level change at 2 years with subsequent coronary heart disease, stroke, cardiovascular disease, total mortality, or endstage renal disease. There was no significant association of incident DM at 2 years with clinical outcomes, except for coronary heart disease ( risk ratio, 1.64; P=. 006), but the risk ratio was lower and nonsignificant in the chlorthalidone group ( risk ratio, 1.46; P=. 14). Conclusions: Fasting glucose levels increase in older adults with hypertension regardless of treatment type. For those taking chlorthalidone vs other medications, the risk of developing FG levels higher than 125 mg/dL (6.9 mmol/L) is modestly greater, but there is no conclusive or consistent evidence that this diuretic-associated increase in DM risk increases the risk of clinical events.
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页码:2191 / 2201
页数:11
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