Selective ß1-blockers are not associated with new-onset diabetes mellitus in hypertensive patients

Yoonjee Park; Byoung Geol Choi; Seung Woon Rha; Man Jong Baek; Yang Gi Ryu; Se Yeon Choi; Jae Kyeong Byun; Min Suk Shim; Ahmed Mashaly; Hu Li; Won Young Jang; Woohyeun Kim; Jun Hyuk Kang; Jah Yeon Choi; Eun Jin Park; Sung Hun Park; Sunki Lee; Jin Oh Na; Cheol Ung Choi; Hong Euy Lim; Eung Ju Kim; Chang Gyu Park; Hong Seog Seo; Dong Joo Oh

doi:10.1097/FJC.0000000000000543

Selective ß1-blockers are not associated with new-onset diabetes mellitus in hypertensive patients

Yoonjee Park, Byoung Geol Choi, Seung Woon Rha, Man Jong Baek, Yang Gi Ryu, Se Yeon Choi, Jae Kyeong Byun, Min Suk Shim, Ahmed Mashaly, Hu Li, Won Young Jang, Woohyeun Kim, Jun Hyuk Kang, Jah Yeon Choi, Eun Jin Park, Sung Hun Park, Sunki Lee, Jin Oh Na, Cheol Ung Choi, Hong Euy LimEung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh

Department of Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Background: Although β-blockers are known to increase newonset diabetes mellitus (DM), previous evidence have been controversial. It has been suggested that newer vasodilatory β-blockers yield better glycemic control than older nonselective agents. The aim of this study was to evaluate the diabetogenicity of currently used newer β-blockers based on β1 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 β-blockers group and non-β-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 β-blockers group had a significantly higher incidence of new-onset DM and MACCE than the non-β-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 β-blockers, and age were independent predictors of new-onset DM. Selective β1-blockers did not increase new-onset DM after adjustment for other antihypertensive medication and statins. Conclusions: In the era of newer β-blockers, selective β1-blockers were not associated with new-onset DM. More evidence is needed to verify this relationship and the underlying mechanisms.

Original language	English
Pages (from-to)	38-45
Number of pages	8
Journal	Journal of Cardiovascular Pharmacology
Volume	71
Issue number	1
DOIs	https://doi.org/10.1097/FJC.0000000000000543
Publication status	Published - 2018 Jan 1

Keywords

Bisoprolol
Carvedilol
Hypertension
Newonset diabetes mellitus
Nonselective β-blockers
Selective β1-blockers

ASJC Scopus subject areas

Pharmacology
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/FJC.0000000000000543

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Park, Y., Choi, B. G., Rha, S. W., Baek, M. J., Ryu, Y. G., Choi, S. Y., Byun, J. K., Shim, M. S., Mashaly, A., Li, H., Jang, W. Y., Kim, W., Kang, J. H., Choi, J. Y., Park, E. J., Park, S. H., Lee, S., Na, J. O., Choi, C. U., ... Oh, D. J. (2018). Selective ß1-blockers are not associated with new-onset diabetes mellitus in hypertensive patients. Journal of Cardiovascular Pharmacology, 71(1), 38-45. https://doi.org/10.1097/FJC.0000000000000543

Selective ß1-blockers are not associated with new-onset diabetes mellitus in hypertensive patients. / Park, Yoonjee; Choi, Byoung Geol; Rha, Seung Woon; Baek, Man Jong; Ryu, Yang Gi; Choi, Se Yeon; Byun, Jae Kyeong; Shim, Min Suk; Mashaly, Ahmed; Li, Hu; Jang, Won Young; Kim, Woohyeun; Kang, Jun Hyuk; Choi, Jah Yeon; Park, Eun Jin; Park, Sung Hun; Lee, Sunki; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo.

In: Journal of Cardiovascular Pharmacology, Vol. 71, No. 1, 01.01.2018, p. 38-45.

Research output: Contribution to journal › Article › peer-review

Park, Y, Choi, BG, Rha, SW, Baek, MJ, Ryu, YG, Choi, SY, Byun, JK, Shim, MS, Mashaly, A, Li, H, Jang, WY, Kim, W, Kang, JH, Choi, JY, Park, EJ, Park, SH, Lee, S, Na, JO, Choi, CU, Lim, HE, Kim, EJ, Park, CG, Seo, HS & Oh, DJ 2018, 'Selective ß1-blockers are not associated with new-onset diabetes mellitus in hypertensive patients', Journal of Cardiovascular Pharmacology, vol. 71, no. 1, pp. 38-45. https://doi.org/10.1097/FJC.0000000000000543

Park, Yoonjee ; Choi, Byoung Geol ; Rha, Seung Woon ; Baek, Man Jong ; Ryu, Yang Gi ; Choi, Se Yeon ; Byun, Jae Kyeong ; Shim, Min Suk ; Mashaly, Ahmed ; Li, Hu ; Jang, Won Young ; Kim, Woohyeun ; Kang, Jun Hyuk ; Choi, Jah Yeon ; Park, Eun Jin ; Park, Sung Hun ; Lee, Sunki ; Na, Jin Oh ; Choi, Cheol Ung ; Lim, Hong Euy ; Kim, Eung Ju ; Park, Chang Gyu ; Seo, Hong Seog ; Oh, Dong Joo. / Selective ß1-blockers are not associated with new-onset diabetes mellitus in hypertensive patients. In: Journal of Cardiovascular Pharmacology. 2018 ; Vol. 71, No. 1. pp. 38-45.

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title = "Selective {\ss}1-blockers are not associated with new-onset diabetes mellitus in hypertensive patients",

abstract = "Background: Although β-blockers are known to increase newonset diabetes mellitus (DM), previous evidence have been controversial. It has been suggested that newer vasodilatory β-blockers yield better glycemic control than older nonselective agents. The aim of this study was to evaluate the diabetogenicity of currently used newer β-blockers based on β1 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 β-blockers group and non-β-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 β-blockers group had a significantly higher incidence of new-onset DM and MACCE than the non-β-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 β-blockers, and age were independent predictors of new-onset DM. Selective β1-blockers did not increase new-onset DM after adjustment for other antihypertensive medication and statins. Conclusions: In the era of newer β-blockers, selective β1-blockers were not associated with new-onset DM. More evidence is needed to verify this relationship and the underlying mechanisms.",

keywords = "Bisoprolol, Carvedilol, Hypertension, Newonset diabetes mellitus, Nonselective β-blockers, Selective β1-blockers",

author = "Yoonjee Park and Choi, {Byoung Geol} and Rha, {Seung Woon} and Baek, {Man Jong} and Ryu, {Yang Gi} and Choi, {Se Yeon} and Byun, {Jae Kyeong} and Shim, {Min Suk} and Ahmed Mashaly and Hu Li and Jang, {Won Young} and Woohyeun Kim and Kang, {Jun Hyuk} and Choi, {Jah Yeon} and Park, {Eun Jin} and Park, {Sung Hun} and Sunki Lee and Na, {Jin Oh} and Choi, {Cheol Ung} and Lim, {Hong Euy} and Kim, {Eung Ju} and Park, {Chang Gyu} and Seo, {Hong Seog} and Oh, {Dong Joo}",

note = "Publisher Copyright: Copyright {\textcopyright} 2017 Wolters Kluwer Health, Inc.",

year = "2018",

month = jan,

day = "1",

doi = "10.1097/FJC.0000000000000543",

language = "English",

volume = "71",

pages = "38--45",

journal = "Journal of Cardiovascular Pharmacology",

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TY - JOUR

T1 - Selective ß1-blockers are not associated with new-onset diabetes mellitus in hypertensive patients

AU - Park, Yoonjee

AU - Choi, Byoung Geol

AU - Rha, Seung Woon

AU - Baek, Man Jong

AU - Ryu, Yang Gi

AU - Choi, Se Yeon

AU - Byun, Jae Kyeong

AU - Shim, Min Suk

AU - Mashaly, Ahmed

AU - Li, Hu

AU - Jang, Won Young

AU - Kim, Woohyeun

AU - Kang, Jun Hyuk

AU - Choi, Jah Yeon

AU - Park, Eun Jin

AU - Park, Sung Hun

AU - Lee, Sunki

AU - Na, Jin Oh

AU - Choi, Cheol Ung

AU - Lim, Hong Euy

AU - Kim, Eung Ju

AU - Park, Chang Gyu

AU - Seo, Hong Seog

AU - Oh, Dong Joo

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Although β-blockers are known to increase newonset diabetes mellitus (DM), previous evidence have been controversial. It has been suggested that newer vasodilatory β-blockers yield better glycemic control than older nonselective agents. The aim of this study was to evaluate the diabetogenicity of currently used newer β-blockers based on β1 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 β-blockers group and non-β-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 β-blockers group had a significantly higher incidence of new-onset DM and MACCE than the non-β-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 β-blockers, and age were independent predictors of new-onset DM. Selective β1-blockers did not increase new-onset DM after adjustment for other antihypertensive medication and statins. Conclusions: In the era of newer β-blockers, selective β1-blockers were not associated with new-onset DM. More evidence is needed to verify this relationship and the underlying mechanisms.

AB - Background: Although β-blockers are known to increase newonset diabetes mellitus (DM), previous evidence have been controversial. It has been suggested that newer vasodilatory β-blockers yield better glycemic control than older nonselective agents. The aim of this study was to evaluate the diabetogenicity of currently used newer β-blockers based on β1 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 β-blockers group and non-β-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 β-blockers group had a significantly higher incidence of new-onset DM and MACCE than the non-β-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 β-blockers, and age were independent predictors of new-onset DM. Selective β1-blockers did not increase new-onset DM after adjustment for other antihypertensive medication and statins. Conclusions: In the era of newer β-blockers, selective β1-blockers were not associated with new-onset DM. More evidence is needed to verify this relationship and the underlying mechanisms.

KW - Bisoprolol

KW - Carvedilol

KW - Hypertension

KW - Newonset diabetes mellitus

KW - Nonselective β-blockers

KW - Selective β1-blockers

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DO - 10.1097/FJC.0000000000000543

M3 - Article

C2 - 29286954

AN - SCOPUS:85042715841

VL - 71

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JO - Journal of Cardiovascular Pharmacology

JF - Journal of Cardiovascular Pharmacology

SN - 0160-2446

IS - 1

ER -

Selective ß1-blockers are not associated with new-onset diabetes mellitus in hypertensive patients

Abstract

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ASJC Scopus subject areas

UN SDGs

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