Predictors for Glucose Change in Hypertensive Participants Following Short-term Treatment with Atenolol or Hydrochlorothiazide

The hyperglycemia associated with the most commonly prescribed antihypertensive drug classes is of growing concern to the medical community. It is well documented that β-blockers and thiazide diuretics cause adverse metabolic effects, and large-scale studies and meta-analyses provide compelling data indicating that β-blockers and thiazide diuretics increase the risk of diabetes.1–5 The ability to discern which participants are at greatest risk for hyperglycemia associated with β-blockers and thiazide diuretics or the development of diabetes would be valuable to clinicians4,6–9. Previous studies found that African ancestry, higher body mass index, left ventricular hypertrophy, higher follow-up systolic blood pressure, elevated baseline glucose, uric acid, female sex, and age are associated with the development of diabetes after long-term β-blocker and/or thiazide diuretic therapy. 3, 4, 10, 11 One study found that African ancestry, lower baseline glucose, and urinary sodium excretion were significant predictors for change in glucose after hydrochlorothiazide (HCTZ) monotherapy.12 To date, no studies have evaluated predictors for glucose change associated with β-blockers. Given that hyperglycemia and diabetes associated with the use of thiazide diuretics and β-blockers may offset the clinical benefit of these two drug classes,10, 13–15 it is important to identify the clinical characteristics that increase risk. If such factors could be identified, they might be useful to guide selection of antihypertensive therapy. Therefore, the goal of the current study was to determine the clinical characteristics associated with change in glucose and impaired fasting glucose (IFG) following treatment with atenolol or HCTZ.