Long-Term Effects of Diabetes on Cardiovascular Outcomes in People Treated for Hypertension

Some medications used to treat hypertension may lead to an increased occurrence of diabetes….

Antihypertensive medications such as thiazide diuretics lead to higher rates of diabetes compared to other medications used to lower blood pressure. A study was conducted which compared the effect of calcium channel blockers, angiotensin converting enzyme inhibitors and diuretics on cardiovascular disease (CVD) in the long run.

Results from 22,418 subjects were taken from the ALLHAT or Antihypertensive and Lipid Lowering treatment to Prevent Heart Attack trial, and put into one of three categories: baseline diabetes, incidence diabetes, or no diabetes. Mortality associated with cardiovascular disease was the primary outcome. This outcome includes heart failure, stroke, coronary heart disease, or other types of cardiovascular disease. Other outcomes studied were non-CVD mortality, all-cause mortality, and coronary heart disease.

Subjects taking a diuretic known as chlorthalidone with incidence diabetes compared to those with no diabetes had a lower, insignificant risk for CVD mortality and non-CVD mortality than subjects who were taking a calcium channel blocker such as amlodipine or an angiotension converting enzyme inhibitor such as lisinopril.

Researchers found that participants who had incident diabetes also had a higher risk of coronary heart disease than those subjects who did not have diabetes. Participants who were taking chlorthalidone had a significantly decreased risk of coronary heart disease than the participants on lisinopril.

In conclusion, researchers found that thiazide associated incident diabetes has fewer harmful long term cardiovascular disease complications than incidence diabetes associated with other antihypertensive medications. 

Joshua I. Barzilay, Barry R. Davis, et all. Circ Cardiovasc Qual Outcomes. 2012; 5(2): p. 153-162