A retrospective longitudinal cohort study of antihypertensive drug use and new-onset diabetes in Taiwanese patients.

Antihypertensive drugs have been linked to new-onset diabetes (NOD); however, data on the effect of these drugs on the development of NOD in hypertensive patients has not been well determined in a clinical setting. The aim was to investigate the association between antihypertensive drugs and NOD in Taiwan. We conducted a retrospective study of hypertensive Taiwanese patients receiving antihypertensive drugs treatment between January 2006 and December 2011. Clinical information and laboratory parameters were collected by reviewing the medical records. We estimated the odds ratios (ORs) of NOD associated with antihypertensive drug use; nondiabetic subjects served as the reference group. A total of 120 NOD cases were identified in 1001 hypertensive patients during the study period. The risk of NOD after adjusting sex, age, baseline characteristics, and lipid profiles was higher among users of thiazide diuretics (OR, 1.65; 95% confidence interval (CI), 1.12-2.45) and nondihydropyridine (non-DHP) calcium channel blockers (CCBs) (OR, 1.96; 95% CI, 1.01-3.75) than among nonusers. Other antihypertensive drug classes were not associated with risk of NOD. Our results show that patients with hypertension who take thiazide diuretics and non-DHP CCBs are at higher risk of developing NOD than those who take other classes of antihypertensive drugs in Taiwan.

Statins and new-onset diabetes: a retrospective longitudinal cohort study.

BACKGROUND: Statins have been linked to new-onset diabetes (NOD); however, the effect of statins on the development of NOD in patients with hypertension and dyslipidemia has not been well studied. OBJECTIVE: The goal of this study was to investigate the association between statins and NOD. METHODS: This was a retrospective cohort study performed by using data from claim forms provided to the central regional branch of the Bureau of National Health Insurance in Taiwan from July 2006 to December 2009. Prescriptions for statins before the index date were retrieved from a prescription database. We estimated the hazards ratios (HRs) of NOD associated with statin use. Nondiabetic subjects served as the reference group. RESULTS: A total of 1360 (8.5%) NOD cases were identified among 16,027 patients with hypertension and dyslipidemia during the study period. The risk of NOD after adjusting for sex and age was higher among users of pravastatin (HR, 1.34 [95% CI, 1.15-1.55]) and atorvastatin (HR, 1.29 [95% CI, 1.16-1.44]) than among nonusers. Patients who took fluvastatin (HR, 0.45 [95% CI, 0.34-0.60]), lovastatin (HR, 0.71 [95% CI, 0.61-0.84]), and rosuvastatin (HR, 0.54 [95% CI, 0.39-0.77]) were at lower risk of developing NOD than nonusers. Simvastatin was not associated with risk of NOD. Furthermore, the risk of NOD after adjusting for concomitant medication usage and mean dose of statins was neutral among users of atorvastatin. Pravastatin, fluvastatin, lovastatin, simvastatin, and rosuvastatin produced similar results as adjusting for sex and age. CONCLUSIONS: These outpatients with hypertension and dyslipidemia who took fluvastatin, lovastatin, and rosuvastatin were at lower risk of NOD, whereas patients who took pravastatin were at greater risk. Simvastatin and atorvastatin seemed to have a neutral effect. Our study also demonstrated that atorvastatin has a dose-response effect on NOD risk. Because this was a descriptive study, temporality and subsequent causality of all statins and NOD could not be shown. Further study and independent confirmation of the causality between statin use and NOD in larger clinical trials are warranted.

The long-term effect of statins on the risk of new-onset diabetes mellitus in elderly Taiwanese patients with hypertension and dyslipidaemia: a retrospective longitudinal cohort study.

BACKGROUND: HMG-CoA reductase inhibitors (statins) have been linked to new-onset diabetes (NOD). Individual statins may differ in the extent to which they increase the risk for NOD; however, the effect of statins on the development of NOD in elderly hypertensive and dyslipidaemic patients has not been well studied. OBJECTIVE: The aim of this study was to investigate the relative risk for NOD among elderly (age ≥65 years) hypertensive and dyslipidaemic Taiwanese patients who received different statins. METHODS: This was a retrospective cohort study performed using data from claim forms provided to the central regional branch of the Bureau of National Health Insurance in Taiwan from July 2004 to December 2009. Prescriptions for statins before the index date were retrieved from a prescription database. We estimated the hazard ratios (HRs) of NOD associated with statin use. Non-diabetic subjects served as the reference group. RESULTS: A total of 2735 NOD cases were identified among 15,637 elderly hypertensive and dyslipidaemic patients during the study period. The risk of NOD after adjusting for sex, age, concomitant medication and mean dose of prescription was lower among users of atorvastatin (HR 0.77; 95% CI 0.71, 0.83) and rosuvastatin (HR 0.65; 95% CI 0.51, 0.82) than among non-users. Patients who took lovastatin (HR 1.38; 95% CI 1.26, 1.50) or simvastatin (HR 1.30; 95% CI 1.14, 1.48) were at higher risk of developing NOD than non-users. Pravastatin and fluvastatin were not associated with increased risk of NOD. CONCLUSIONS: The results of this study suggest that elderly hypertensive and dyslipidaemic patients who take atorvastatin or rosuvastatin are at lower risk of NOD. Lovastatin and simvastatin were associated with a significant increase in the risk of NOD.

Antihypertensive drugs and new-onset diabetes: a retrospective longitudinal cohort study.

Antihypertensive drugs have been linked to new-onset diabetes (NOD); however, data on the effect of these drugs on the development of NOD in hypertensive patients has not been well determined. We aimed to investigate the association between antihypertensive drugs and NOD. This was a retrospective cohort study performed using data from claim forms provided to the central region branch of the Bureau of National Health Insurance in Taiwan from January 2002 to December 2007. Prescriptions for antihypertensive drugs before the index date were retrieved from a prescription database. We estimated the odds ratios (ORs) of NOD associated with antihypertensive drug use; nondiabetic subjects served as the reference group. A total of 4233 NOD cases were identified in 24,688 hypertensive patients during the study period. The risk of NOD after adjusting for sex and age was higher among users of diuretics (OR = 1.10, 95% confidence interval [CI]= 1.01-1.20), beta-blockers (BBS; OR = 1.12, 95% CI = 1.04-1.21), and calcium channel blockers (CCBs; OR = 1.10, 95% CI = 1.02-1.18) than among nonusers. Patients who take angiotensin-converting enzyme (ACE) inhibitors (OR = 0.92, 95% CI = 0.84-1.00), angiotensin receptor blockers (ARB; OR = 0.90, 95% CI = 0.81-0.98), or alpha-blockers (OR = 0.88, 95% CI = 0.80-0.98) are at a lower risk of developing NOD than nonusers. Vasodilators were not associated with the risk of NOD. The results of this study suggest that hypertensive patients who take ACE inhibitors, ARBs, or alpha-blockers are at a lower risk of NOD. Diuretics, BBs, and CCBs were associated with a significant increase in the risk of NOD.

The relationship between antihypertensive combination therapies comprising diuretics and/or beta-blockers and the risk of new-onset diabetes: a retrospective longitudinal cohort study.

We investigate the associations of antihypertensive drugs in double and triple combination regimens comprising diuretics and/or beta-blockers on the development of new-onset diabetes (NOD). This study was a retrospective cohort study carried out using data from claim forms provided to the central regional branch of the Bureau of National Health Insurance (BNHI) in Taiwan from January 2001 to December 2006. We estimated the odds ratios (ORs) of NOD associated with antihypertensive combination therapy use; non-NOD individuals served as the reference group. A total of 2361 NOD cases were identified among the 12,386 hypertensive patients (6143 men and 6243 women, aged 28-86 years (mean age: 68+11)) during the study period. The risk of NOD was higher after adjusting for age and sex among users of double combinations of diuretics plus beta-blockers (adjusted OR, 1.25; 95% confidence interval (CI): 1.12-1.58), diuretics plus calcium channel blockers (CCBs; adjusted OR: 1.14; 95% CI: 1.06-1.26) and beta-blockers plus calcium channel blockers (adjusted OR: 1.12; 95% CI: 1.04-1.29) than that among non-users. Patients who took angiotensin-converting enzyme (ACE) inhibitors, or alpha-blockers as part of a double-drug regimen were at a lower risk of developing NOD than were non-users. Double- or triple-drug combinations comprising angiotensin receptor blockers (ARBs) and vasodilators were not associated with risk of NOD. The results of this study suggest that users of double-drug combination therapies containing diuretics and/or beta-blockers and an ACE inhibitor or alpha-blocker are at a significantly lower risk of developing NOD than are other classes.

Long-term effects of antihypertensive drugs on the risk of new-onset diabetes in elderly Taiwanese hypertensives.

Antihypertensive drugs have been linked to new-onset diabetes (NOD); however, the effects of these drugs on the development of NOD in elderly Taiwanese hypertensive patients have not been well determined. We examined the association between antihypertensive drug therapy and the risk of NOD in a population-based study. The sample consisted of 8,638 elderly hypertensive patients. The data were obtained from claim forms provided to the central region branch of the Bureau of National Health Insurance in Taiwan from January 2001 to December 2006. Prescriptions for antihypertensive drugs before the index date were retrieved from a prescription database. We estimated the odds ratios (ORs) of NOD associated with antihypertensive drug use; nondiabetic subjects served as the reference group. The risk of NOD was higher among users of diuretics (OR, 1.12; 95% confidence interval [CI], 1.04-1.21), and beta-blockers (OR, 1.11; 95% CI, 1.02-1.20) than among nonusers. Patients who take angiotensin-converting enzyme (ACE) inhibitors (OR, 0.90; 95% CI, 0.82-0.98) or alpha-blockers (OR, 0.88; 95% CI, 0.78-0.99) are at a lower risk of developing NOD than nonusers. Angiotensin receptor blockers, calcium channel blockers, and vasodilators were not associated with risk of NOD. The results suggest that elderly hypertensive patients who take ACE inhibitors or alpha-blockers are at lower risk of NOD. Diuretics and beta-blockers were associated with a significant increase in the risk of NOD.

Long-term efficacy and safety of very-low-dose amiodarone treatment for the maintenance of sinus rhythm in patients with chronic atrial fibrillation after successful direct-current cardioversion.

BACKGROUND: Long-term maintenance of sinus rhythm after successful conversion of chronic atrial fibrillation (CAF), often ameliorates patients' symptoms, reduces the risk of ischemic stroke and improves cardiovascular hemodynamics. This prospective study aims to evaluate the long-term efficacy and safety of very low-dose amiodarone (100 mg daily) for the maintenance of sinus rhythm after successful direct-current (DC) cardioversion in patients with CAF and rheumatic heart disease (RHD) post intervention. METHODS: This study was a randomized prospective trial. One day after successful DC cardioversion (remained normal sinus rhythm) in patients with CAF and RHD post intervention for more than six months and adequate anticoagulation, all were randomly administered either amiodarone 200 mg daily in group A or amiodarone 100 mg daily in group B. RESULTS: A total of 76 patients (40 men and 36 women) were examined from February 1998 to December 1999. The mean age of the patients was (66 +/- 10) years, and the mean follow-up was (67 +/- 8) months (range 61 to 84 months). Actuarial rates of the maintenance of sinus rhythm were similar in the two groups after 5 years of follow-up. Four patients (11%) in group A but none in group B experienced significant adverse effects that necessitated withdrawal of amiodarone. No death occurred during the study period. CONCLUSION: A very low dose of amiodarone results in adequate long-term efficacy and is safe for maintaining sinus rhythm in patients with CAF and RHD post intervention after successful DC cardioversion.