Shorr R I, Ray W A, Daugherty J R, Griffin M R
Department of Preventive Medicine, University of Tennessee-Memphis College of Medicine and Methodist Hospitals of Memphis, 38104, USA.
JAMA. 1997 Jul 2;278(1):40-3.
Beta-Blockers and angiotensin-converting enzyme (ACE) inhibitors are effective antihypertensive agents for patients with diabetes mellitus. However, beta-blockers attenuate some components of the autonomic response to hypoglycemia and could increase the risk of hypoglycemia. ACE inhibitors may increase insulin sensitivity and predispose users to hypoglycemia.
To determine whether use of cardioselective beta-blockers, nonselective beta-blockers, ACE inhibitors, thiazide diuretics, calcium channel blockers, or other antihypertensive drugs alters the risk of developing serious hypoglycemia among older persons prescribed insulin or sulfonylureas.
Retrospective cohort study.
Tennessee Medicaid Program.
A total of 13,559 elderly (mean age, 78+/-7 years) Medicaid enrollees, who were prescribed insulin (n=5171, 38%) or sulfonylureas (n=8368, 62%) from 1985 through 1989. These enrollees contributed a total of 33,107 person-years of insulin or sulfonylurea use for follow-up.
Hospitalization, emergency department admission, or death associated with hypoglycemic symptoms and a concomitant blood glucose determination of less than 2.8 mmol/L (50 mg/dL).
We identified 598 persons with an episode of serious hypoglycemia during the study period. The rate of serious hypoglycemia was 2.01 per 100 person-years among those who were not prescribed antihypertensives. Crude rates of serious hypoglycemia were highest among users of ACE inhibitors (2.47 per 100 person-years) and lowest among users of cardioselective beta-blockers (1.23 per 100 person-years). However, when we controlled for demographic characteristics and markers of comorbidity, there was no statistically significant increase or decrease in risk of serious hypoglycemia among users of any class of antihypertensive agents compared with nonusers of antihypertensive drugs. Using nonselective beta-blockers as the reference group, each of these agents was associated with a lower, but not statistically significant, risk of hypoglycemia.
In this population, specific antihypertensive drug therapy had little impact on the risk of hypoglycemia in older diabetic patients. Therapy should be chosen based on other considerations of safety and effectiveness.
β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂是糖尿病患者有效的抗高血压药物。然而，β受体阻滞剂会减弱对低血糖的自主神经反应的某些成分，并可能增加低血糖风险。ACE抑制剂可能会增加胰岛素敏感性并使使用者易发生低血糖。
确定使用心脏选择性β受体阻滞剂、非选择性β受体阻滞剂、ACE抑制剂、噻嗪类利尿剂、钙通道阻滞剂或其他抗高血压药物是否会改变在使用胰岛素或磺脲类药物的老年人中发生严重低血糖的风险。
回顾性队列研究。
田纳西医疗补助计划。
共有13559名老年（平均年龄78±7岁）医疗补助计划参保者，他们在1985年至1989年期间使用胰岛素（n = 5171，38%）或磺脲类药物（n = 8368，62%）。这些参保者总共贡献了33107人年的胰岛素或磺脲类药物使用随访时间。
与低血糖症状相关的住院、急诊就诊或死亡，以及同时测定的血糖低于2.8 mmol/L（50 mg/dL）。
我们在研究期间确定了598例严重低血糖发作的患者。未服用抗高血压药物者的严重低血糖发生率为每100人年2.01例。严重低血糖的粗发生率在ACE抑制剂使用者中最高（每100人年2.47例），在心脏选择性β受体阻滞剂使用者中最低（每100人年1.23例）。然而，当我们控制了人口统计学特征和合并症指标后，与未使用抗高血压药物者相比，任何一类抗高血压药物使用者的严重低血糖风险均无统计学上的显著增加或降低。以非选择性β受体阻滞剂作为参照组，这些药物中的每一种都与较低但无统计学意义的低血糖风险相关。
在该人群中，特定的抗高血压药物治疗对老年糖尿病患者的低血糖风险影响很小。应基于其他安全性和有效性考虑来选择治疗方法。
