DETERMINANTS OF NEW-ONSET DIABETES AMONG 19,257 HYPERTENSIVE PATIENTS RANDOMISED IN THE ASCOT-BPLA TRIAL AND THE RELATIVE INFLUENCE OF ANTIHYPERTENSIVE MEDICATION

Objectives: To determine the baseline predictors of new-onset diabetes (NOD) in hypertensive patients, and to develop a risk score to identify those at high risk of NOD. Research Design and Methods: Among 19257 hypertensive patients in ASCOT-BPLA that were randomised to receive one of two antihypertensive regimens: atenolol ± thiazide or amlodipine ± perindopril, 14120 were ‘at risk’ of developing diabetes at baseline. Of these, 1366 (9.7%) subsequently developed NOD during median follow-up of 5.5 years. A multivariate Cox model was developed to identify the independent predictors of NOD, and individual risk scores Results: NOD was significantly associated with increase in baseline fasting plasma glucose (FPG), BMI, serum triglyceride and systolic blood-pressure (SBP). In contrast, amlodipine ± perindopril in comparison with atenolol ± thiazide treatment (HR 0.66 95%CI 0.59 to 0.74), high HDLc, alcohol use and age >55 years were found to be significantly protective factors. FPG was the most powerful predictor with risk increasing by 5.8 times (95%CI 5.23 to 6.43) for each mmol/l rise above 5 mmol/l. Risk of NOD increased steadily with increasing quartile of risk score, with a nineteen-fold increase (95% CI 14.3 to 25.4) among those in the highest compared with those in the lowest quartile. The model showed excellent internal validity and discriminative ability. Conclusions: Baseline FPG >5mmol/l, BMI and use of an atenolol ± diuretic regimen were among the major determinants of NOD in hypertensive patients. The model developed from these data allows accurate prediction of NOD among hypertensive subjects Out of 14210 at risk patients, 1428 (10.1%) patients in all had non-fasting values of either triglycerides (n=1392:atenolol-based treatment (n=705) & amiodipine-based treatment (n=687)) or FPG(n=1427:atenolol-based treatment (n=725) & amiodipine-based treatment (n=702) or both Abbreviations: diviation, ischaemic

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