Baseline Factors Predict New-Onset Diabetes in Patients With Hypertension

Blood Pressure Lowering Arm of ASCOT (ASCOT-BPLA) investigators have looked as risk factors for developing new onset diabetes(NOD).

Study Highlights

• Study data were drawn from the ASCOT-BLPA trial, which enrolled patients between the ages of 40 and 79 years with hypertension plus 3 other cardiovascular risk factors. Patients with a previous history of coronary heart disease were excluded from study participation, and patients with diabetes at baseline were excluded from the current analysis.
• Subjects were randomized to receive atenolol plus a thiazide diuretic as required for uncontrolled hypertension or amlodipine plus perindopril as required.
• The main outcome of the current study was the discovery of variables that increased the risk for new-onset diabetes, which was defined by 1999 World Health Organization Criteria.
• 19,257 subjects were included in ASCOT-BLPA, and 14,120 were considered to be at risk for the development of new-onset diabetes. The mean age of subjects was 62 years, and 78% of participants were men.
• The median follow-up period was 5.5 years, and 1366 subjects had development of new-onset diabetes during this period.
• Higher fasting plasma glucose levels, body mass index, systolic blood pressure, and triglyceride levels independently increased the risk for new-onset diabetes. Elevated fasting plasma glucose level was the biggest risk factor, with a hazard ratio of 5.8 for each 1-mmol/L increase in fasting plasma glucose levels of more than 5 mmol/L.
• The use of atenolol plus a possible thiazide diuretic increased the risk for new-onset diabetes by 25%. Conversely, randomization to the amlodipine-based regimen reduced the risk for new-onset diabetes by 34%.
• Higher levels of total and HDL cholesterol along with age older than 55 years and alcohol use reduced the risk for new-onset diabetes.
• Combining different risk factors for new-onset diabetes, those in the highest quartile of risk experienced a hazard ratio of 19.04 for new-onset diabetes vs participants in the lowest quartile of risk.
• The authors estimate that 30 patients would need to receive amlodipine plus perindopril instead of atenolol plus a thiazide diuretic for at least 5 years to prevent 1 additional case of new-onset diabetes.

This study is published in recent Diabetic Care.