All concepts, explanations, trials, and studies have been
re-written in plain English and may contain errors. I am
not a doctor
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Increased Risk Of Diabetes From Blood Pressure Drugs

 2000 - Small studies have suggested that thiazide
diuretics and beta-blockers may cause type II diabetes.
	The ARIC (Atherosclerosis Risk In
Communities) study followed 12,550 non-diabetic
people from 45 to 64 years of age, for up to 6 years.
	Roughly 30% had high blood pressure and
were more likely to be fat, old, and African-American.
These people were 2-1/2 times more likely to develop
type 2 diabetes as those with normal blood pressure.
	After statistically adjusting for other diabetes
risk factors, people taking beta-blockers still had 28%
higher risk for developing diabetes. There was no
increased risk for those taking ACE inhibitors, calcium
channel blockers, or thiazide diuretics compared to no
therapy at all.

Title:      Hypertension and antihypertensive therapy as
               risk factors for type II diabetes mellitus.
Authors: Gress TW, Nieto FJ, Shahar E, et al, for the
              Atherosclerosis Risk In Communities Study.
Source:  N Engl J Med. 2000;342:905-912.

COMMENT:

Although previous observational studies suggest that
high dose diuretics (50 to 200 mg hydrochlorthiazide)
place patients at increased risk for type 2 diabetes, this
well-designed study suggests that patients on diuretics
are no more likely to develop diabetes than those on
ACE inhibitors or calcium channel blockers.
	Those on beta-blockers were more likely to
develop diabetes.
	This study suggests that in patients with high
blood pressure at increased risk for diabetes (family
history, obesity, steroid use), ACE inhibitors, diuretics
and calcium channel blockers are preferred to beta-
blockers for treating high blood pressure.
	However, this does not condemn beta-
blockers in treating high blood pressure. As recently
shown in the UKPDS (United Kingdom Prospective
Diabetes Study), beta-blockers improve outcome once
diabetes exists.
	So risk for causing diabetes must be
weighed against beta-blockers' proven benefit in
reducing cardiovascular events once diabetes exists.