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

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.