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Blood pressure lowe...
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Nazarzadeh, MiladUniv Oxford, Deep Med, Oxford Martin Sch, Oxford, England.;Univ Oxford, Nuffield Dept Womens & Reprod Hlth, Div Med Sci, Oxford, England.
(author)
Blood pressure lowering and risk of new-onset type 2 diabetes : an individual participant data meta-analysis
- Article/chapterEnglish2021
Publisher, publication year, extent ...
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Elsevier,2021
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electronicrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:uu-459891
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-459891URI
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https://doi.org/10.1016/S0140-6736(21)01920-6DOI
Supplementary language notes
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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BackgroundBlood pressure lowering is an established strategy for preventing microvascular and macrovascular complications of diabetes, but its role in the prevention of diabetes itself is unclear. We aimed to examine this question using individual participant data from major randomised controlled trials.MethodsWe performed a one-stage individual participant data meta-analysis, in which data were pooled to investigate the effect of blood pressure lowering per se on the risk of new-onset type 2 diabetes. An individual participant data network meta-analysis was used to investigate the differential effects of five major classes of antihypertensive drugs on the risk of new-onset type 2 diabetes. Overall, data from 22 studies conducted between 1973 and 2008, were obtained by the Blood Pressure Lowering Treatment Trialists' Collaboration (Oxford University, Oxford, UK). We included all primary and secondary prevention trials that used a specific class or classes of antihypertensive drugs versus placebo or other classes of blood pressure lowering medications that had at least 1000 persons-years of followup in each randomly allocated arm. Participants with a known diagnosis of diabetes at baseline and trials conducted in patients with prevalent diabetes were excluded. For the one-stage individual participant data meta-analysis we used stratified Cox proportional hazards model and for the individual participant data network meta-analysis we used logistic regression models to calculate the relative risk (RR) for drug class comparisons.Findings145 939 participants (88 500 [60.6%] men and 57 429 [39.4%] women) from 19 randomised controlled trials were included in the one-stage individual participant data meta-analysis. 22 trials were included in the individual participant data network meta-analysis. After a median follow-up of 4.5 years (IQR 2.0), 9883 participants were diagnosed with new-onset type 2 diabetes. Systolic blood pressure reduction by 5 mm Hg reduced the risk of type 2 diabetes across all trials by 11% (hazard ratio 0.89 [95% CI 0.84-0.95]). Investigation of the effects of five major classes of antihypertensive drugs showed that in comparison to placebo, angiotensin-converting enzyme inhibitors (RR 0.84 [95% 0.76-0.93]) and angiotensin II receptor blockers (RR 0.84 [0.76-0.92]) reduced the risk of new-onset type 2 diabetes; however, the use of beta blockers (RR 1.48 [1.27-1.72]) and thiazide diuretics (RR 1.20 [1.07-1.35]) increased this risk, and no material effect was found for calcium channel blockers (RR 1.02 [0.92-1.13]).InterpretationBlood pressure lowering is an effective strategy for the prevention of new-onset type 2 diabetes. Established pharmacological interventions, however, have qualitatively and quantitively different effects on diabetes, likely due to their differing off-target effects, with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers having the most favourable outcomes. This evidence supports the indication for selected classes of antihypertensive drugs for the prevention of diabetes, which could further refine the selection of drug choice according to an individual's clinical risk of diabetes.
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Bidel, ZeinabUniv Oxford, Deep Med, Oxford Martin Sch, Oxford, England.;Univ Oxford, Nuffield Dept Womens & Reprod Hlth, Div Med Sci, Oxford, England.
(author)
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Canoy, DexterUniv Oxford, Deep Med, Oxford Martin Sch, Oxford, England.;Univ Oxford, Nuffield Dept Womens & Reprod Hlth, Div Med Sci, Oxford, England.;Oxford Univ Hosp NHS Fdn Trust, NIHR Oxford Biomed Res Ctr, Oxford, England.
(author)
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Copland, EmmaUniv Oxford, Deep Med, Oxford Martin Sch, Oxford, England.;Univ Oxford, Nuffield Dept Womens & Reprod Hlth, Div Med Sci, Oxford, England.
(author)
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Wamil, MalgorzataUniv Oxford, Deep Med, Oxford Martin Sch, Oxford, England.
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Majert, JeannetteUniv Oxford, Deep Med, Oxford Martin Sch, Oxford, England.;Univ Oxford, Nuffield Dept Womens & Reprod Hlth, Div Med Sci, Oxford, England.
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Byrne, Karl SmithInt Agcy Res Canc WHO, Genom Epidemiol Branch, Lyon, France.
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Sundström, Johan,Professor,1971-Uppsala universitet,Klinisk epidemiologi,Univ New South Wales, George Inst Global Hlth, Sydney, NSW, Australia.(Swepub:uu)johasund
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Teo, KoonMcMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada.
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Davis, Barry R.Univ Texas Sch Publ Hlth, Houston, TX USA.
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Chalmers, JohnUniv New South Wales, George Inst Global Hlth, Sydney, NSW, Australia.
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Pepine, Carl J.Univ Florida, Dept Med, Gainesville, FL USA.
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Dehghan, AbbasImperial Coll London, Dept Biostat & Epidemiol, Sch Publ Hlth, London, England.
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Bennett, Derrick A.Univ Oxford, Clin Trial Serv Unit, Nuffield Dept Populat Hlth, Oxford, England.;Univ Oxford, Epidemiol Studies Unit, Nuffield Dept Populat Hlth, Oxford, England.;Oxford Univ Hosp NHS Fdn Trust, NIHR Oxford Biomed Res Ctr, Oxford, England.
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Smith, George DaveyUniv Bristol, Integrat Epidemiol Unit, Bristol, Avon, England.
(author)
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Rahimi, KazemUniv Oxford, Deep Med, Oxford Martin Sch, Oxford, England.;Univ Oxford, Nuffield Dept Womens & Reprod Hlth, Div Med Sci, Oxford, England.;Oxford Univ Hosp NHS Fdn Trust, NIHR Oxford Biomed Res Ctr, Oxford, England.
(author)
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Univ Oxford, Deep Med, Oxford Martin Sch, Oxford, England.;Univ Oxford, Nuffield Dept Womens & Reprod Hlth, Div Med Sci, Oxford, England.Univ Oxford, Deep Med, Oxford Martin Sch, Oxford, England.;Univ Oxford, Nuffield Dept Womens & Reprod Hlth, Div Med Sci, Oxford, England.;Oxford Univ Hosp NHS Fdn Trust, NIHR Oxford Biomed Res Ctr, Oxford, England.
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In:The Lancet: Elsevier398:10313, s. 1803-18100140-67361474-547X
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