Selective beta 1-Blockers Are Not Associated With New-onset Diabetes Mellitus in Hypertensive Patients

초록

Background: Although ss-blockers are known to increase new-onset diabetes mellitus (DM), previous evidence have been controversial. It has been suggested that newer vasodilatory ss-blockers yield better glycemic control than older nonselective agents. The aim of this study was to evaluate the diabetogenicity of currently used newer ss-blockers based on ss 1 receptor selectivity in a series of Asian population. Methods: We investigated a total of 65,686 hypertensive patients without DM from 2004 to 2014. Patients with hemoglobin (Hb) A1c <= 6.0%, fasting blood glucose <= 110 mg/dL, and no history of diabetes or diabetic treatment were enrolled for analysis. Patients were divided into the ss-blockers group and non-ss-blockers group. Propensity score matching (PSM) analysis using a logistic regression model was performed to adjust for potential confounders. The primary end point was the cumulative incidence of new-onset DM, defined as a fasting blood glucose >= 126 mg/dL or HbA1c >= 6.5%, and major adverse cardiac and cerebral events (MACCE), defined as a composite of total death, nonfatal myocardial infarction, and cerebrovascular accidents. We investigated predictors of new-onset DM and MACCE based on 2 models, including clinical risk factors and co-medications, respectively. Results: Mean follow-up duration was 30.91 +/- 23.14 months in the entire group before adjustment. The ss-blockers group had a significantly higher incidence of new-onset DM and MACCE than the non-ss-blockers group. After PSM, analysis of a total of 2284 patients (1142 pairs, C-statistic = 0.752) showed no difference between the 2 groups in new-onset DM or MACCE. In multivariate analysis after PSM, baseline HbA1c, stroke, heart failure, nonselective ss-blockers, and age were independent predictors of new-onset DM. Selective ss 1-blockers did not increase new-onset DM after adjustment for other antihypertensive medication and statins. Conclusions: In the era of newer ss-blockers, selective ss 1-blockers were not associated with new-onset DM. More evidence is needed to verify this relationship and the underlying mechanisms.

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