Gress T W, Nieto F J, Shahar E, Wofford M R, Brancati F L
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
N Engl J Med. 2000 Mar 30;342(13):905-12. doi: 10.1056/NEJM200003303421301.
Previous research has suggested that thiazide diuretics and beta-blockers may promote the development of type 2 diabetes mellitus. However, the results of previous studies have been inconsistent, and many studies have been limited by inadequate data on outcomes and by potential confounding.
We conducted a prospective study of 12,550 adults 45 to 64 years old who did not have diabetes. An extensive health evaluation conducted at base line included assessment of medication use and measurement of blood pressure with a random-zero sphygmomanometer. The incidence of new cases of diabetes was assessed after three years and after six years by measurement of serum glucose concentrations while the subjects were fasting.
After simultaneous adjustment for age, sex, race, education, adiposity, family history with respect to diabetes, physical-activity level, other health-related behavior, and coexisting illnesses, subjects with hypertension who were taking thiazide diuretics were not at greater risk for the subsequent development of diabetes than were subjects with hypertension who were not receiving any antihypertensive therapy (relative hazard, 0.91; 95 percent confidence interval, 0.73 to 1.13). Likewise, subjects who were taking angiotensin-converting-enzyme inhibitors and calcium-channel antagonists were not at greater risk than those not taking any medication. In contrast, subjects with hypertension who were taking beta-blockers had a 28 percent higher risk of subsequent diabetes (relative hazard, 1.28; 95 percent confidence interval, 1.04 to 1.57).
Concern about the risk of diabetes should not discourage physicians from prescribing thiazide diuretics to nondiabetic adults who have hypertension. The use of beta-blockers appears to increase the risk of diabetes, but this adverse effect must be weighed against the proven benefits of beta-blockers in reducing the risk of cardiovascular events.
先前的研究表明，噻嗪类利尿剂和β受体阻滞剂可能会促进2型糖尿病的发展。然而，先前研究的结果并不一致，许多研究受到结局数据不足以及潜在混杂因素的限制。
我们对12550名45至64岁无糖尿病的成年人进行了一项前瞻性研究。基线时进行的广泛健康评估包括用药情况评估以及使用随机零点血压计测量血压。通过测量受试者空腹时的血清葡萄糖浓度，在三年和六年后评估糖尿病新发病例的发生率。
在同时调整年龄、性别、种族、教育程度、肥胖、糖尿病家族史、身体活动水平、其他与健康相关的行为以及并存疾病后，服用噻嗪类利尿剂的高血压患者与未接受任何抗高血压治疗的高血压患者相比，后续发生糖尿病的风险并未增加（相对风险，0.91；95%置信区间，0.73至1.13）。同样，服用血管紧张素转换酶抑制剂和钙通道拮抗剂的患者与未服药的患者相比，风险也未增加。相比之下，服用β受体阻滞剂的高血压患者后续患糖尿病的风险高28%（相对风险，1.28；95%置信区间，1.04至1.57）。
对于糖尿病风险的担忧不应阻碍医生为患有高血压的非糖尿病成年人开具噻嗪类利尿剂。使用β受体阻滞剂似乎会增加糖尿病风险，但这种不良反应必须与β受体阻滞剂在降低心血管事件风险方面已证实的益处相权衡。
