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The Glycemic Consequences of Antihypertensive Medications

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Pathophysiology and Pharmacotherapy of Cardiovascular Disease

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Abstract

Thiazide and thiazide-like diuretics are among the oldest and most widely used medications for the treatment of hypertension. They are effective in lowering blood pressure and for preventing cardiovascular disease. The use of these agents has been questioned owing to their metabolic side effects, chief among which are rise in glucose levels and incident diabetes mellitus. Newer antihypertensive agents are preferred by many medical societies since they are considered metabolically neutral or advantageous. In this chapter, we examine the effects of the thiazide-like diuretic, chlorthalidone, on glucose levels through our experience with its use in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). We show that hyperglycemia develops in people treated with chlorthalidone, but elevated glucose levels also occur in people treated with amlodipine and lisinopril. After several years of use, there is no statistically significant difference in glucose levels between them. We further show that incident diabetes mellitus associated with diuretic use has a less severe effect on coronary artery disease than does diabetes mellitus which develops with calcium channel blocker and angiotensin-converting enzyme inhibitor use.

We also discuss the use of first-generation beta-blockers. They, too, have a diabetogenic effect, but, like thiazides, offer many benefits.

We conclude that thiazide and thiazide-like diuretics and older beta-blockers have an important role in hypertension management in the present age of medical care despite their perceived negative metabolic effects.

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Authors and Affiliations

  1. Kaiser Permanente of Georgia and Emory University School of Medicine, Duluth, GA, 30096, USA

    Joshua I. Barzilay MD

  2. Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA

    Paul K. Whelton MB, MD, MSc

  3. Guy S. Parcel Chair in Public Health, University of Texas School of Public Health, Houston, TX, 77025, USA

    Barry R. Davis MD, PhD

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  1. Joshua I. Barzilay MD
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  2. Paul K. Whelton MB, MD, MSc
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  3. Barry R. Davis MD, PhD
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Correspondence to Joshua I. Barzilay MD .

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Editors and Affiliations

  1. Center for Drug Evaluation and Research Division of Cardiovascular and Renal Products, US Food and Drug Administration, Silver Spring, Maryland, USA

    Gowraganahalli Jagadeesh

  2. Pharmacology Unit, AIMST University, Bedong, Malaysia

    Pitchai Balakumar

  3. Center for Drug Evaluation and Research Division of Cardiovascular and Renal Products, US Food and Drug Administration, Silver Spring, Maryland, USA

    Khin Maung-U

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Barzilay, J.I., Whelton, P.K., Davis, B.R. (2015). The Glycemic Consequences of Antihypertensive Medications. In: Jagadeesh, G., Balakumar, P., Maung-U, K. (eds) Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Adis, Cham. https://doi.org/10.1007/978-3-319-15961-4_44

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  • DOI: https://doi.org/10.1007/978-3-319-15961-4_44

  • Publisher Name: Adis, Cham

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