Meta-analysis of 94,492 patients with hypertension treated with beta Blockers to determine the risk of new-onset diabetes Mellitus
Meta-analysis of 94,492 patients with hypertension treated with beta Blockers to determine the risk of new-onset diabetes Mellitus
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DOI：
10.1016/j.amjcard.2007.05.057
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发表时间：
2007-10-15
影响因子：
2.8
通讯作者：
Messerli, Franz H.
中科院分区：
文献类型：
--
作者：
Bangalore, Sripal;Parkar, Sanobar;Messerli, Franz H.
用于治疗高血压的β受体阻滞剂可能与新发糖尿病（DM）风险增加相关。对Medline、PubMed和EMBASE进行了检索，以查找接受0阻滞剂作为高血压一线治疗的患者的随机对照试验，以及新发DM和随访1年的数据。12项研究评估了94，492例患者，符合纳入标准。与非利尿抗高血压药物相比，β受体阻滞剂治疗导致新发DM的风险增加22%（相对风险1.22，95%置信区间[CI] 1.12至1.33）。基线空腹血糖水平较高（比值比[OR] 1.01，95% CI 1.00 - 1.02，p = 0.004），收缩压（OR 1.05，95% CI 1.05 - 1.08，p = 0.001）和舒张压（OR 1.06，95% CI 1.0 - 1. 10，p = 0.0 11）2种治疗方式之间的血压差异是新发DM的重要单变量预测因素。多变量荟萃回归分析显示，较高的基线体重指数（OR 1.17，95%CI 1.01至1.33，p = 0.034）是新发DM的重要预测因素。在老年人和R受体阻滞剂降压效果较差的研究中，阿替洛尔的糖尿病风险更大，且随着R受体阻滞剂持续时间的增加呈指数增加。对于次要终点，β受体阻滞剂导致卒中风险增加15%，而对死亡或心肌梗死终点没有益处。总之，与其他药物相比，13种阻滞剂与新发DM风险增加相关，对死亡或心肌梗死终点无获益，卒中风险增加15%。在基线体重指数和基线空腹血糖水平较高的患者中，以及与其他治疗相比，β受体阻滞剂降压效果较差的研究中，这种风险更大。(C)2007年爱思唯尔公司All rights reserved.
Beta blockers used for the treatment of hypertension may be associated with increased risk for new-onset diabetes mellitus (DM). A search of Medline, PubMed, and EMBASE was conducted for randomized controlled trials of patients taking 0 blockers as first-line therapy for hypertension with data on new-onset DM and follow-up for :l year. Twelve studies evaluating 94,492 patients fulfilled the inclusion criteria. Beta-blocker therapy resulted in a 22% increased risk for new-onset DM (relative risk 1.22, 95% confidence interval [CI] 1.12 to 1.33) compared with nondiuretic antihypertensive agents. A higher baseline fasting glucose level (odds ratio [OR] 1.01, 95% CI 1.00 to 1.02, p = 0.004) and greater systolic (OR 1.05, 95% CI 1.05 to 1.08, p = 0.001) and diastolic (OR 1.06, 95% CI 1.0 1 to 1. 10, p = 0.0 11) blood pressure differences between the 2 treatment modalities were significant univariate predictors of new-onset DM. Multivariate meta-regression analysis showed that a higher baseline body mass index (OR 1.17, 95% CI 1.01 to 1.33, p = 0.034) was a significant predictor of new-onset DM. The risk for DM was greater with atenolol, in the elderly, and in studies in which R blockers were less efficacious antihypertensive agents and increased exponentially with increased duration on R blockers. For the secondary end points, beta blockers resulted in a 15% increased risk for stroke, with no benefit for the end point of death or myocardial infarction. In conclusion, 13 blockers are associated with an increased risk for new-onset DM, with no benefit for the end point of death or myocardial infarction and with a 15% increased risk for stroke compared with other agents. This risk was greater in patients with higher baseline body mass indexes and higher baseline fasting glucose levels and in studies in which beta blockers were less efficacious antihypertensive agents compared with other treatments. (C) 2007 Elsevier Inc. All rights reserved.