Antihypertensive Therapy for Patients with Asthma and Prediabetes

Primary Recommendations

The American Diabetes Association recommends ACE inhibitors or ARBs as first-line antihypertensive therapy for patients with prediabetes, as they reduce cardiovascular events without worsening glucose metabolism 1, 2, 3
ACE inhibitors and ARBs are metabolically neutral or beneficial, and do not impair glucose tolerance, worsen hyperglycemia, or increase insulin resistance, making them ideal for patients with prediabetes 5
The American Diabetes Association explicitly recommends ACE inhibitors and ARBs as first-line therapy for hypertension in patients with diabetes or prediabetes 4

Dihydropyridine calcium channel blockers, such as amlodipine, are an excellent alternative if ACE inhibitors/ARBs are not tolerated, as they are metabolically neutral and provide proven cardiovascular benefits 1, 2, 3
Calcium channel blockers do not adversely affect glucose metabolism or lipid profiles, and are safe in patients with asthma 4

Beta-blockers are contraindicated in patients with asthma due to the risk of bronchospasm, and also increase insulin resistance and worsen glucose tolerance 5
Thiazide diuretics should be avoided as first-line therapy in patients with prediabetes, as they impair glucose tolerance, increase insulin resistance, and cause hyperuricemia and dyslipidemia 5

When initiating an ACE inhibitor or ARB, monitor serum creatinine and potassium within 7-14 days, then at least annually, to minimize the risk of renal dysfunction 1, 2, 4, 5
If blood pressure remains uncontrolled, add a dihydropyridine calcium channel blocker as the preferred second agent, or a thiazide-like diuretic as a second-line agent if needed 3, 4, 5