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Item
#3
Blood
Glucose Increase During Antihypertensive Treatment Increases MI
Risk
ACE-inhibitors
or calcium antagonists may be better choices.
Insulin
resistance and the metabolic impact of beta blockers and diuretics
together increase the risk of myocardial infarction in patients
being treated for hypertension, Swedish researchers report.
The
investigators studied 1860 men who had participated in a health
survey from 1970 to 1973 at the age of 50. The men were
re-examined at age 60 and then followed for 17.4 years.
About
23% of patients treated for hypertension experienced a myocardial
infarction after the age of 60, compared with 13.5% of men who had
not been treated for hypertension, report Dr. Kristin Dunder and
colleagues from Uppsala University.
An
increase in blood glucose level between age 50 and 60 was an
independent risk factor for myocardial infarction in patients who
were receiving beta blockers and thiazide diuretics, but not in
men without such treatment, they report in the March 29th issue of
the British Medical Journal.
High
serum proinsulin at baseline, a marker of insulin resistance, was
also found to be a risk factor for myocardial infarction.
Patients
with the highest proinsulin levels also were the ones with the
highest blood glucose value.
Previous
studies have shown that hypertensive patients are at higher risk
of developing insulin resistance than are normotensive patients.
Treating patients with high blood pressure with beta blockers or
diuretics that affect the metabolic state has therefore been
questioned, according to the present study, which indicates that
both an insulin resistant state and the metabolic impact of beta
blockers and diuretics can increase the risk of myocardial
infarction.
Results
showed that one should consider whether patients with a metabolic
syndrome and hypertension really should be given treatment with a
beta blocker or a thiazide diuretic. ACE-inhibitors or calcium
antagonists may be better choices. BMJ
2003;326:681-685.
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