Angiotensin II receptor blockers decreased blood glucose levels: a longitudinal survey using data from electronic medical records

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Abstract

Abstract

Background:
A beneficial effect on glucose metabolism is reported with angiotensin receptor blocker (ARB) treatment of hypertension. The effect on blood glucose level during the course of treatment with ARBs in clinical cases is uncertain. Our objectives were to survey the changes in glucose and HbA1c levels in patients with hypertension over a one-year period, and to study the correlations between these values and the time after the start of ARB therapy.

Methods:
We conducted a retrospective longitudinal survey of blood glucose and HbA1c measurements in Japanese patients aged ≥20 years with newly diagnosed hypertension but without diabetes, who had received ARB monotherapy with candesartan cilexetil, losartan potassium, olmesartan medoxomil, telmisartan, or valsartan during the period from December 2004 to November 2005. Data including 2465 measurements of non-fasting blood glucose in 485 patients and 457 measurements of HbA1c in 155 patients were obtained from electronic medical records of Nihon University School of Medicine. Linear mixed effects models were used to analyze the relationship between these longitudinal data of blood examinations and covariates of patient age, sex, medication, and duration of ARB therapy.

Results:
Casual blood glucose level was associated with the duration of treatment (P < 0.0001), but not with age, sex, or medication. Blood glucose level was significantly decreased during the periods of 0~3 months (P < 0.0001) and 3~6 months (P = 0.0081) compared with baseline, but was not significantly different between 6~12 months and baseline. There was no association between HbA1c level and covariates of sex, age, medication and duration of treatment.

Conclusion:
Our findings provide new clinical evidence that the effects of ARBs on glucose metabolism may change during the course of treatment, suggesting a blood glucose-lowering effect in the short-term after the start of treatment.

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Background
Clinically, there are many cases in which abnormal glucose metabolism and hypertension appear together. Knowing the effects of blood pressure-lowering agents on blood glucose is important for the treatment of hypertensive patients with abnormalities of glucose metabolism or diabetes. The agents most often used for hypertension today include angiotensin receptor blockers (ARB) and angiotensin converting enzyme (ACE) inhibitors, which are both considered to improve glucose metabolism 1,2. In addition, much attention has been paid to a prospective clinical trial that showed that ACE inhibitors suppressed the new onset of diabetes 3. A subsequent report showed that ARBs also suppressed the new onset of diabetes 4. The magnitude of this effect was around 20–25%. Recent animal experiments have suggested improvement of insulin resistance by ARBs 5,6. Clarification of the mechanism of this effect is in progress.

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