Which antihypertensive class may mask signs of hypoglycemia in diabetic patients?

• A. Beta blockers
• B. ACE inhibitors
• C. Calcium channel blockers
• D. Loop diuretics

Answer: (A)

Beta-adrenergic blockade can hide the early warning signs of hypoglycemia in diabetes. When blood glucose drops, the body releases catecholamines that trigger sympathetic symptoms such as tachycardia, tremor, and anxiety to warn the person that something is wrong. Blocking beta receptors blunts these signs, making hypoglycemia harder to recognize. Additionally, beta blockers—especially nonselective ones that block both beta-1 and beta-2 receptors—can impair hepatic glucose production by inhibiting beta-2–mediated glycogenolysis and gluconeogenesis, potentially worsening or prolonging hypoglycemia. Other antihypertensives don’t suppress these adrenergic warning signs to the same extent, so they’re less likely to mask hypoglycemia.