Some Blood Pressure Drugs Boost Diabetes Risk

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How doctors should be prescribing these drugs in light of these findings isn't clear cut, Elliott said. "In Britain, they have issued new guidelines, where, in fact, the diuretic and beta blocker combination are not to be used together because of the excess risk of diabetes," he said.

Doctors who take a patient's risk for diabetes into account might be better off prescribing an ACE inhibitor or an ARB, rather than a beta blocker or a diuretic as first-line treatment, Elliott said.

"However, if you have a patient who has high blood pressure, kidney disease and had a major heart attack recently -- there is no question they are going to get the beta blocker to protect them from another heart attack," he said. "They are also going to get diuretic, because of the kidney disease. If they get diabetic, you just accept that and move on. You are not going deny them the medicines they need today over the risk of diabetes down the road," he said.

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One diabetes expert thinks that doctors should take a patient's risk for diabetes into account when prescribing blood pressure medications.

"Individualization of therapy is important," said Dr. Stuart Weiss, an endocrinologist at New York University Medical Center. "With the explosion of diabetes in the country, we need to take that into consideration when providing patients with their initial antihypertensive."

Weiss thinks that those people who are at risk for diabetes should not be started on beta blockers or diuretics. "With all the data about the long-term use of ACEs and ARBs and their lower risk for diabetes, it's a good thing to get these drugs in early in somebody who is even at modest risk for type 2 diabetes," he said.

A cardiologist agreed that treatment needs to be tailored to individual patient needs.

"Since doctors generally have many drug options to lower blood pressure, it makes sense to tailor the drug choice to the patient who may be at higher risk for certain diseases," said Dr. Byron K. Lee, an assistant professor of medicine at University of California San Francisco, Division of Cardiology.

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