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Blood Pressure Drug Increases Diabetes Risk

Patients with metabolic syndrome (a precursor to diabetes) who also have high blood pressure or hypertension should be wary of taking a class of drugs called thiazide-type diuretics (TZ) because it may increase their risk of developing diabetes, results of a new study say.

Results of STAR (Study of Trandolapril/Verapamil-SR and Insulin Resistance) show that using a TZ in combination with a blood pressure-lowering drug called a renin-angiotensin system (RAS) blocker increased the risk of developing diabetes among patients who have the metabolic syndrome and hypertension.

STAR compared the effects of a RAS inhibitor combined with a TZD and a RAS inhibitor combined with another class of blood pressure-lowering medication called calcium channel blockers (CCBs) in maintaining blood sugar control in hypertensive patients with metabolic syndrome.

Study investigators used a fixed-dose combination of trandolapril plus verapamil, marketed as Tarka, versus a fixed-dose combination of losartan plus hydrochlorothiazide (HCTZ), marketed as Hyzaar. Results of STAR show that blood sugar control significantly worsened in the losartan/HCTZ group versus the trandolapril/verapamil SR group. It was further shown that the 21 percent of people in STAR who remained on the low dose losartan/HCTZ had a significantly higher risk for developing diabetes at the end of the study. In contrast, the fixed-dose combination of trandolapril/verapamil SR effectively lowered blood pressure without worsening blood sugar control.

The findings suggest that using a RAS blockade with a TZ did not protect against the negative metabolic effects associated with the TZ. Researchers likewise suggest the need for reassessing the current management of hypertensive patients with metabolic syndrome for whom a metabolically neutral add-on therapy to RAS inhibition might be a more appropriate choice than a TZ to further reduce blood pressure without worsening blood sugar control.

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