• A fixed level of 5 mmHg reduction in systolic BP reduced the risk of diabetes by 11%. This treatment effect constituted quantitatively and qualitatively diverging effects of major antihypertensive drug classes. In analysis of specific drug classes versus placebo, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers had the strongest protective effect on the risk of diabetes. For calcium channel blockers no material effect was found, while β blockers and thiazide diuretics increased the risk

• Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers should become the drugs of choice when clinical risk of diabetes is of concern, whereas β blockers and thiazide diuretics should be avoided where possible.

Reference

• Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis (Lancet, 2021)