Nov. 15, 2021 -- The lowering of blood pressure-- known to prevent complications of type 2 diabetes such as heart disease -- can also stop diabetes from getting started, , although the effects vary according to the type of drug taken, results of a new study show.

ACE inhibitors such as Lisinopril , and angiotensin II receptor blockers, such as Valsartan, show the strongest association with diabetes prevention, while beta-blockers, like Acebutolol, and diuretics were linked to an increased risk of diabetes.

“This study suggests that blood pressure lowering can help prevent diabetes in addition to its well-established beneficial effects in reducing cardiovascular events,” write Milad Nazarzadeh and colleagues in The Lancet.

“In particular, ACE inhibitors and ARBs should become the drugs of choice when clinical risk of diabetes is of concern, whereas beta blockers and thiazide diuretics should be avoided where possible,” note Nazarzadeh, of the University of Oxford in the United Kingdom, and co-authors.

In an editorial published alongside this study, Matthew A. Cavender, MD, MPH, and Robert C. Wirka, MD, of the University of North Carolina at Chapel Hill, agree that the new findings -- along with the bulk of previous evidence-- point to an important role of different drugs in diabetes prevention.

They note that, while “the absolute risk reduction found in this [study] is modest, interventions with small benefits can have an outsized effect when applied to conditions as common as hypertension.”

Results Fill Gap in Evidence for Guidelines:

Nazarzadeh and colleagues say that because it’s not clear if lowering blood pressure causes the lower risk of diabetes, treatment guideline recommendations have been lacking.

However, they now believe “our study fills this gap in evidence.”

Under European Society of Cardiology (guidelines, these drugs are recommended for treating high blood pressure, but diabetes and heart societies in the U.S. only recommend them over other drugs for patients who have some evidence of kidney damage, such as protein in their urine.

But because an estimated 13% of all Americans have diabetes and a striking 34.5% having prediabetes, the need for more measures to tackle the problem is urgent, say Cavender and Wirka in their editorial.

“Perhaps these data are enough to encourage the writers of the hypertension guidelines in the USA to follow the lead of the ESC,” they say.

Medscape Medical News

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