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

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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 languageEnglish
Pages (from-to)38-45
Number of pages8
JournalJournal of Cardiovascular Pharmacology
Volume71
Issue number1
DOIs
Publication statusPublished - 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

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  • Cite this

    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