To the Editor.
—Dr Shorr and colleagues1 address the important and timely issue of hypoglycemia in elderly diabetic patients concurrently treated with antihypertensives. Despite the authors' careful discussion of some inherent limitations of the study, the interpretation of the results remains problematic. Single relative risk (RR) estimates do not reach nominal statistical significance, and 95% confidence intervals (CIs) are generally very wide. Only among insulin users does the use of β-blockers carry an increased risk of hypoglycemia. Interestingly, the same agents are associated with the lowest RR estimate (RR, 0.25) among users of sulfonylureas.More information on antidiabetic agents might have been useful. Indeed, not all sulfonylureas are alike, and some are more liable to induce serious hypoglycemia, particularly when drug elimination is reduced by renal impairment.2 In addition, beef/pork insulin results in hypoglycemic warning symptoms more often than does human insulin in older diabetic persons.3The
Gambassi G, Carbonin P, Bernabei R. Risk of Hypoglycemia With Antihypertensive Medication. JAMA. 1997;278(19):1569-1570. doi:10.1001/jama.1997.03550190033030