Antihypertensives and Hypoglycemia in Diabetics
The majority of older diabetics require antihypertensive medication in addition to treatment of their diabetes. Hypoglycemia is an unwanted consequence of therapy. Beta blockers and ACE inhibitors, as well as some other agents, have a potential to increase this likelihood. Beta blockers may blunt the sympathetically mediated warning signs of hypoglycemia, delaying recognition and correction maneuvers, and may impair the glucagon response to hypoglycemia. ACE inhibitors may increase insulin sensitivity, thereby lowering glucose. Although there is strong literature support for the use of either of these two classes of agents to treat hypertension in diabetics, whether consequences like serious hypoglycemia are increased to a clinically relevant level has been little examined.
In a population of 13,559 persons (mean age, 78), 598 suffered at least one episode of serious hypoglycemia. Only the use of non-selective beta blockers in patients on insulin was associated with a statistically significant, two-fold increased risk of hypoglycemia. The authors conclude that concern about serious hypoglycemia induced by cardioselective beta blockers and ACE inhibitors should not be factors affecting therapeutic choices for diabetic hypertensives.
Shorr R, et al. JAMA 1997;278:40-43.
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