Atherosclerosis Risk in Communities - ARIC


Risk of type 2 diabetes with antihypertnsive therapies.


To determine if thiazide diuretics and beta-blockers promote the development of type 2 diabetes mellitus.

Study Design

Study Design:

Patients Screened: 15,792
Patients Enrolled: 12,550
NYHA Class: Not reported
Mean Follow Up: 6 years
Mean Patient Age: 45-64 years
Female: 56%
Mean Ejection Fraction: Not evaluated

Patient Populations:

12,550 adults aged 45-64 years old (3804 subjects with hypertension [defined as SBP of 140 mmHg or greater, DBP of 90 mmHg or more, or medication use for hypertension]).


For this analysis, the following participants were excluded: those with preexisting diabetes, race other than black or white, missing data at baseline, and missing data at 3 year or 6 year follow-up examinations.

Primary Endpoints:

Development of type 2 diabetes mellitus (defined as presence of any of following: fasting blood glucose of 126 mg/dL or greater, nonfasting glucose of 200 mg/dL or more, use of insulin or an oral hypoglycemic drug, or physician's diagnosis of diabetes).

Drug/Procedures Used:

The following categories of hypertensive medications were considered in the analyses: ACE inhibitors, beta-blockers, calcium channel anatgonists, and thiazide diuretics.

Principal Findings:

There were 29.1 new cases of diabetes per 1000 patient years among hypertensive subjects versus only 12.0 per 1000 patient years in nonhypertensive subjects (RR 2.43, 95% 2.16-2.73). After adjustments for multiple risk factors (age, sex, race, education, adiposity, fmaliy history, activity level, coexisting illnesses), hypertensive subjects who were taking thiazide diuretics were not at increased risk for developing diabetes compared to hypertensive subjects not on any antihypertensive therapy (relative hazard 0.91, 95% CI 0.73-1.13). Subjects taking ACE inhibitors or calcium channel antagonists were also not at increased risk than those not taking any medication. In contrast, hypertensive subjects taking beta-blockers had a significantly higher risk of devloping type 2 diabetes (relative hazard 1.28, 95% CI 1.04-1.57).


Type II diabetes mellitus was more than twice as likely to develop in those with hypertension than in normotensive persons. The use of thiazide diuretics in hypertensive individuals did not increase the risk of developing diabetes. In contrast, the use of beta-blockers was associated with an increased risk of developing diabetes.


N Engl J Med 2000;342:905-912.

Clinical Topics: Prevention, Statins, Hypertension

Keywords: Diabetes Mellitus, Type 2, Diuretics, Adiposity, Risk Factors, Hydrochlorothiazide, Hypertension, Calcium Channel Blockers, Sodium Chloride Symporter Inhibitors

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