A new analysis of data from the landmark Anglo-Scandinavian Cardiac Outcomes Trial – Blood Pressure Lowering Arm (ASCOT-BPLA) published in Diabetes Care has identified the major predictors of new onset diabetes (NOD) in patients with hypertension.
In particular, the data show that hypertensive patients allocated to amlodipine and the ACE inhibitor perindopril (Coversyl) were 34% (HR 0.64 95% CI 0.59 to 0.74) less likely to develop NOD compared with those allocated to a β-blocker/diuretic combination (atenolol ± thiazide).
For the investigators, given the evidence from ASCOT-BPLA and previous trials, it seems that the beneficial effect of the amlodipine/perindopril regimen is largely a composition of the protective effect of Coversyl, amlodipine playing a neutral role, whereas atenolol and thiazide have adverse effects.
The benefits of perindopril on NOD have not always been seen with all other RAAS inhibitors – the recent analyses of the DREAM trial did not show a significantly protective effect of ramipril against NOD.
More recently, in the STAR trial, an ACEI/CCB antihypertensive regimen was superior to an ARB/thiazide diuretic in reducing the risk of NOD.
“This new ASCOT-BPLA analyses provide robust evidence that treating hypertensive patients with a regimen based on amlodipine and perindopril, in comparison to atenolol and thiazide, significantly reduces the risk of NOD,” states Dr Ajay Gupta, lead author and Research Fellow at the International Centre for Circulatory Health, Heart & Lung Institute, Imperial College, London.
“Unfortunately, β-blockers and diuretics, often in combination, are used extensively worldwide. If we translate our findings into patient numbers in the US for example, 250,000 cases of NOD each year related to the use of β-blocker and diuretic combinations could be avoided.
“It therefore seems at best unwise to use these drugs in preference to others such as a calcium channel blocker plus an ACE inhibitor, particularly since the latter combination has been shown to be more cost-effective.”