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Calcium channel blocker monotherapy versus combination with renin-angiotensin system blockers in the development of new-onset diabetes mellitus in hypertensive Korean patients
Authors : YH Kim (Chuncheon City,KR), A-Y Her (Chuncheon City,KR), S-W Rha (Seoul,KP), BG Choi (Seoul,KP), A Mashaly (Seoul,KP), Y Park (Seoul,KP), WY Jang (Seoul,KP), W Kim (Seoul,KP), JY Choi (Seoul,KP), EJ Park (Seoul,KP), JO Na (Seoul,KP), CU Choi (Seoul,KP), EJ Kim (Seoul,KP), CG Park (Seoul,KP), HS Seo (Seoul,KP)
Background: Among the antihypertensive drugs, the development of new-onset diabetes mellitus (NODM) is unchanged or increased by thiazide diuretics and beta-blockers and unchanged or decreased by angiotensin converting enzyme inhibitors (ACEI), calcium channel blockers (CCB), and angiotensin receptor blockers (ARB). The aim of this study was to investigate whether there are additional beneficial actions of combination therapy of renin-angiotensin system inhibitors (RASI) which include ACEI or ARB, with CCB over CCB monotherapy in the development of NODM during 5 years follow-up periods.
Methods: A total of 3208 consecutive hypertensive patients without a history of diabetes mellitus who prescribed CCB were retrospectively enrolled using the electronic database of Korea University Guro Hospital from January 2004 to December 2012. They were divided into the two groups according to the additional use of RASI (the RASI group, n=1,221 and the no RASI group, n=1,987). Primary endpoint was NODM, defined as a fasting blood glucose ≥126mg/dL or hemoglobin A1c ≥6.5%. Secondary endpoint were individual and composite major adverse cardiac events (MACE) defined as total death, cardiac death, myocardial infarction (MI) and percutaneous coronary intervention (PCI).
Results: After PSM analysis, two propensity-matched groups (939 pairs, n=1,878, C-statistic = 0.743) were generated and the baseline characteristics of the two groups were balanced. Up to 5 years, there were similar incidence of NODM (Hazard ratio [HR]; 0.975, 95% confidence interval [CI]; 0.697–1.362, p=0.880), MACE (HR; 1.000, 95% CI; 0.634–1.578, p=0.999), total death, MI, and PCI between the two groups (Figure).
Conclusions: In the present study, the use of RASI in addition to CCB did not show significant reduction of the development of NODM and individual and composite major clinical outcomes compared to CCB monotherapy up to 5 years.