Nazarzadeh M, Bidel Z, Canoy D, et al. - New-onset type 2 diabetes can be effectively prevented by ensuring blood pressure lowering. In addition, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers provide the most favorable outcomes.

• A one-stage individual participant data meta-analysis included 19 randomized controlled trials comprising 145,939 participants (88,500 [60·6%] men and 57,429 [39·4%] women), to determine the impact of blood pressure lowering per se on the risk of new-onset type 2 diabetes.

• The individual participant data network meta-analysis involved 22 trials.

• Across all trials, reduction in the risk of type 2 diabetes by 11% was brought about by decreasing systolic blood pressure by 5 mm Hg (hazard ratio 0·89 [95% CI 0·84–0·95]).

• Testing five major classes of antihypertensive drugs, it was revealed that the risk of new-onset type 2 diabetes was reduced by angiotensin-converting enzyme inhibitors (relative risk RR: 0·84) and angiotensin II receptor blockers (RR 0·84) vs placebo; however, an increased risk was noted with β blockers (RR 1·48) and thiazide diuretics (RR 1·20).

• For calcium channel blockers, no material effect was identified (RR 1·02).

• Qualitatively and quantitively different impacts of established pharmacological interventions on diabetes were evident, possibly because of their differing off-target effects.

• This evidence backs the indication for selected classes of antihypertensive drugs for the prevention of diabetes.