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Antihypertensive drug therapy and hypoglycemia in elderly diabetic patients treated with insulin and/or sulfonylureas

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Abstract

We performed this case–control study to evaluate the risk of hypoglycemia associated with the use of antihypertensive drugs in older hospitalized diabetic patients treated with sulfonylureas and/or insulin. All diabetic patients admitted during 4 months in 1988, 1 month in 1991, 4 months in 1993 and 4 months in 1995 (n = 3477, mean age 71.4 ± 0.2 years, 1542 males and 1935 females) were enrolled in the study. During the four annual surveys 86 patients (mean age 71.1 ± 1.4 years, 33 males and 53 females) presented hypoglycemia during hospital stay. The patients who presented hypoglycemia were less frequently users of sulfonylureas and more frequently users of a combination of insulin and sulfonylureas. Use of antihypertensive drugs was similar in the two groups studied, and among potentially interacting drugs considered in the analysis, sulfonamides were more frequently used in patients who experienced hypoglycemia. Moreover, patients with hypoglycemia used a higher number of drugs, had a longer length of stay and had a greater prevalence of hypoglycemia as admission problem. Finally, although not significant, liver and renal diseases were more frequent among patients with hypoglycemia. In the multivariate analysis, contemporary use of insulin and sulfonylureas, liver disease and length of stay were significantly associated with hypoglycemia, while none of the antihypertensive drugs showed a significant association with the occurrence of hypoglycemia during hospital stay. Our results indicate that antihypertensive drugs do not increase the risk of hypoglycemia in elderly diabetic patients.

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References

  1. Meneilly GS, Cheung E, Tuokko H. Counterregulatory hormone response to hypoglycemia in the elderly patient with diabetes. Diabetes 1994; 43: 403–410.

    Google Scholar 

  2. Curb JD, Pressel SL, Cutler JA, et al., for the Systolic Hypertension in the Elderly Program Cooperative Research Group. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated hypertension. JAMA 1996; 276: 1886–1892.

    Google Scholar 

  3. Yusuf S, Peto R, Lewis J, Collins R, Sleight P. Beta blockade during and after myocardial infarction: An overview of the randomized trials. Prog Cardiovasc Dis 1985; 27: 335–371.

    Google Scholar 

  4. Zuanetti G, Latini R. Impact of pharmacological treatment on mortality after myocardial infarction in diabetic patients. J Diabetes Complications 1997; 11: 131–136.

    Google Scholar 

  5. Donnelly R. Angiotensin-converting enzyme inhibitors and insulin sensitivity: Metabolic effects in hypertension, diabetes and heart failure. J Cardiovasc Pharmacol 1992; 20(Suppl. 11): S38–S44.

    Google Scholar 

  6. Uehara M, Kishikawa H, Isami S, et al. Effect on insulin sensitivity of angiotensin converting enzyme inhibitors with or without sulphydryl group: Bradikinin may improve insulin resistance in dogs and humans. Diabetologia 1994; 37: 300–307.

    Google Scholar 

  7. Arauz-Pacheco C, Ramirez LC, Rios JM, Raskin P. Hypoglycemia induced by angiotensin-converting enzyme inhibitors in patients with non-insulin dependent diabetes mellitus receiving sulfonylurea therapy. Am J Med 1990; 89: 811–813.

    Google Scholar 

  8. Rett K, Wicklmair M, Dietze GJ. Hypoglycemia in hypertensive diabetic patients treated with sulfonilureas, biguanides and captopril. N Engl J Med 1988; 319: 1609.

    Google Scholar 

  9. Herings RM, de Boer A, Stricker BH, Leufkens HG, Porsius A. Hypoglycemia associated with use of inhibitors of angiotensin-converting enzyme. Lancet 1995; 345: 1195–1198.

    Google Scholar 

  10. Morris AD, Boyle DI, McMahon AD, Pearce H, Evans JM, Newton RW, Jung RT, MacDonald TM. Ace inhibitors use is associated with hospitalization for severe hypoglycemia in patients with diabetes. DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside, Scotland. Medicines Monitoring Unit. Diabetes Care 1997; 20(9): 1363–1367.

    Google Scholar 

  11. Winocur P, Waldek S, Anderson DC. Captopril and blood glucose. Lancet 1986; ii: 461.

    Google Scholar 

  12. Passa P, LeBlanc H, Marre M. Effects of enalapril in insulin-dependent diabetic subjects with mild to moderate uncomplicated hypertension. Diabetes Care 1987; 10: 200–204.

    Google Scholar 

  13. Seefeldt T, Orskov L, Mengel A, et al. Lack of effects of angiotensin-converting enzyme (ACE)-inhibitors on glucose metabolism in type I diabetes. Diabetic Med 1990; 7: 700–704.

    Google Scholar 

  14. Seghieri G, Yin W, Boni C, Sanna G, Anichini R, Bartolomei G, Ferrannini E. Effect of chronic ACE inhibition on glucose tolerance and insulin sensitivity in hypertensive type 2 diabetic patients. Diabetic Med 1992; 9: 732–738.

    Google Scholar 

  15. Oksa A, Gajdos M, Fedelesova V, Spustova V, Dzurik R. Effects of angiotensin-converting enzyme inhibitors on glucose and lipid metabolism in essential hypertension. J Cardiovasc Pharmacol 1992; 23: 79–86.

    Google Scholar 

  16. Shorr RI, Ray WA, Daugherty JR, Griffin MR. Antiypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas. JAMA 1997; 278: 40–43.

    Google Scholar 

  17. Moore N, Kreft-Jais C, Haramburu F, Noblet C, Andrejak M, Ollagnier M, Bégaud B. Reports of hypoglycemia associated with the use of ACE inhibitors and other drugs: A case/non-case study in the French pharmacovigilance system database. Br J Clin Pharmacol 1997; 44: 513–518.

    Google Scholar 

  18. Pahor M, Psaty BM, Furberg CD. Treatment of hypertensive patients with diabetes. Lancet 1998; 351: 689–690.

    Google Scholar 

  19. Ravid M, Lang R, Rachmani R, Lishner M. Long-term renoprotective effect of angiotensin-converting enzyme inhibition in non-insulin dependent diabetes mellitus: A 7–years follow-up study. Arch Intern Med 1996; 156: 286–289.

    Google Scholar 

  20. Pahor M, Guralnik JM, Gambassi Jr G, Bernabei R, Carosella L, Carbonin PU. The impact of age on the risk of adverse drug reactions to digoxin. J Clin Epidemiol 1993; 46: 1305–1314.

    Google Scholar 

  21. Pahor M, Bernabei R, Carosella L, Gambassi Jr G, Manto A, Carbonin PU. Mental status can bias detection of adverse drug reactions in hospitalized patients. Facts Res Gerentol 1993; 7: 271–275.

    Google Scholar 

  22. Carbonin PU, Pahor M, Bernabei R, Sgadari A. Is age an independent risk factor of adverse drug reactions in hospitalized medical parients? J Am Geriatr Soc 1991; 39: 1093–1099.

    Google Scholar 

  23. Pahor M, Mugelli A, Guralnik JM, et al. Age and laxative use in hospitalized patients. A report of the Gruppo Italiano di Farmacovigilanza nell'Anziano (GIFA). Aging (Milano) 1995; 7: 128–135.

    Google Scholar 

  24. World Health Organization. International drug monitoring: The role of the hospital. WHO Tech Rep Ser No. 425, 1969.

  25. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239–245.

    Google Scholar 

  26. Pahor M, Chrischilles EA, Guralnik JM, Brown SL, Wallace RB, Carbonin PU. Drug data coding and analysis in epidemiologic studies. Eur J Epidemiol 1994; 10: 405–411.

    Google Scholar 

  27. PHS-HCF. International classification of dieases, 9th revision. Clinical modifications. Washington, DC: Public Health Service — Health Care Financing Administration 1980.

    Google Scholar 

  28. Charlson ME, Pompei P, Ales KL, Mackenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chron Dis 1987; 40: 373–383.

    Google Scholar 

  29. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9–CM administrative database. J Clin Epidemiol 1992; 45: 613–619.

    Google Scholar 

  30. Oates JA, Wilkinson GR. Principles of drug therapy. In: Braunwald E, Isselbacher KJ, Petersdorf RG, Wilson JD, Martin JB, Fauci AS (eds), Principles of internal medicine, 11th edn. New York: McGraw-Hill, 1987: 342–352.

    Google Scholar 

  31. van Staa T, Abenhaim L, Monette J. Rates of hypoglycemia in users of sulfonylureas. J Clin Epidemiol 1997; 50(6): 735–741.

    Google Scholar 

  32. Hekimsoy Z, Biberoglu S, Comlekci A, Tarhan O, Mermut C, Biberoglu K. Trimethoprim/sulfamethoxazole-induced hypoglycemia in a malnourished patient with severe infection. Eur J Endocrinol 1997; 136: 304–306.

    Google Scholar 

  33. Lee AJ, Maddix DS. Trimethoprim/sulfamethoxazole-induced hypoglycemia in a patient with acute renal failure. Ann Pharmacother 1997; 31: 727–732.

    Google Scholar 

  34. Deacon SP, Karunanayake A, Barnett D. Acebutolol, atenolol, propranolol and metabolic responses to acute hypoglycaemia in diabetics. Br Med J 1977; 2: 1255–1257.

    Google Scholar 

  35. Kerr D, MacDonald IA, Heller SR, Tattersall RB. Beta-adrenoceptor blockade and hypoglycaemia: A randomised, double-blind placebo-controlled comparison of metoprolol CR, atenolol, and propranol LA in normal subjects. Br J Clin Pharmacol 1990; 29: 685–693.

    Google Scholar 

  36. Tse WY, Kendall M. Is there a role for beta-blockers in hypertensive diabetic patients? Diabet Med 1994; 11: 137–144.

    Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, University of Messina, Cosenza

    Andrea Corsonello, Francesco Corica, Alba Malara, Vittorio Nicita Mauro & Domenico Ceruso

  2. Division of Geriatric Medicine and Neuromotor Rehabilitation – Stroke Unit, Italian National Research Centres on Aging (INRCA), Cosenza

    Andrea Corsonello

  3. Department of Internal Medicine and Geriatrics, Catholic University, Rome, Italy

    Claudio Pedone, Luciana Carosella, Antonio Sgadari & Pierugo Carbonin

  4. Sticht Center on Aging, Department of Internal Medicine, Wake Forest University, Winston Salem, NC, USA

    Marco Pahor

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  1. Andrea Corsonello
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  2. Claudio Pedone
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  3. Francesco Corica
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Corsonello, A., Pedone, C., Corica, F. et al. Antihypertensive drug therapy and hypoglycemia in elderly diabetic patients treated with insulin and/or sulfonylureas. Eur J Epidemiol 15, 893–901 (1999). https://doi.org/10.1023/A:1007645904709

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