Beta blockers used for the treatment of hypertension may be associated with increased
risk for new-onset diabetes mellitus (DM). A search of Medline, PubMed, and EMBASE
was conducted for randomized controlled trials of patients taking β blockers as first-line
therapy for hypertension with data on new-onset DM and follow-up for ≥1 year. Twelve
studies evaluating 94,492 patients fulfilled the inclusion criteria. Beta-blocker
therapy resulted in a 22% increased risk for new-onset DM (relative risk 1.22, 95%
confidence interval [CI] 1.12 to 1.33) compared with nondiuretic antihypertensive
agents. A higher baseline fasting glucose level (odds ratio [OR] 1.01, 95% CI 1.00
to 1.02, p = 0.004) and greater systolic (OR 1.05, 95% CI 1.05 to 1.08, p = 0.001)
and diastolic (OR 1.06, 95% CI 1.01 to 1.10, p = 0.011) blood pressure differences
between the 2 treatment modalities were significant univariate predictors of new-onset
DM. Multivariate meta-regression analysis showed that a higher baseline body mass
index (OR 1.17, 95% CI 1.01 to 1.33, p = 0.034) was a significant predictor of new-onset
DM. The risk for DM was greater with atenolol, in the elderly, and in studies in which
β blockers were less efficacious antihypertensive agents and increased exponentially
with increased duration on β blockers. For the secondary end points, β blockers resulted
in a 15% increased risk for stroke, with no benefit for the end point of death or
myocardial infarction. In conclusion, β blockers are associated with an increased
risk for new-onset DM, with no benefit for the end point of death or myocardial infarction
and with a 15% increased risk for stroke compared with other agents. This risk was
greater in patients with higher baseline body mass indexes and higher baseline fasting
glucose levels and in studies in which β blockers were less efficacious antihypertensive
agents compared with other treatments.
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Article info
Publication history
Accepted:
May 11,
2007
Received in revised form:
May 11,
2007
Received:
April 25,
2007
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
