Antihypertensive Therapy and Incidence of Type 2 Diabetes in an Elderly Cohort

<jats:p>OBJECTIVE—The aim of this study was to determine whether the incidence of type 2 diabetes differed among elderly users of four major antihypertensive drug classes.</jats:p> <jats:p>RESEARCH DESIGN AND METHODS—This was a retrospective, observational cohort study of previously untreated elderly patients (aged ≥66 years) identified as new users of an antihypertensive drug class between April 1995 and March 2000. Using a Cox proportional hazards model, the primary analysis compared diabetes incidence in users of ACE inhibitors, β-blockers, and calcium channel blockers (CCBs), with thiazide diuretics allowed as second-line therapy. In the secondary analysis, thiazide diuretics were added as a fourth study group.</jats:p> <jats:p>RESULTS—In the multivariable-adjusted primary analysis (n = 76,176), neither ACE inhibitor use (hazard ratio 0.96 [95% CI 0.84–1.1]) nor β-blocker use (0.86 [0.74–1.0]) was associated with a statistically significant difference in type 2 diabetes incidence compared with the CCB control group. In the secondary analysis (n = 100,653), compared with CCB users, type 2 diabetes incidence was not significantly different between users of ACE inhibitors (0.97 [0.83–1.1]), β-blockers (0.84 [0.7–1.0]), or thiazide diuretics (1.0 [0.89–1.2]).</jats:p> <jats:p>CONCLUSIONS—Type 2 diabetes incidence did not significantly differ among users of the major antihypertensive drug classes in this elderly, population-based administrative cohort. These results do not support the theory that different antihypertensive drug classes are relatively more or less likely to cause diabetes.</jats:p>