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Hypertension in type 2-diabetic patients—effects of endogenous insulin and antidiabetic therapies

2000; Oxford University Press; Volume: 13; Issue: 6 Linguagem: Inglês

10.1016/s0895-7061(00)00455-6

1941-7225

J Rosenthal,

Metabolism, Diabetes, and Cancer

Hypertension is present in almost 50% of newly diagnosed type 2 diabetic patients. Insulin resistance as a possible trigger of both hypertension and type 2 diabetes is usually linked to compensatory hyperinsulinemia. Insulin has been described as increasing sodium reabsorption and stimulating the sympathetic nervous system. The question as to whether high insulin levels enhance the progression of hypertension was investigated in a long-term clinical study. A total of 76 overweight (BMI: A: 29.1 ± 4.3; G: 28.8 ± 4.3) type 2 diabetic patients with mild hypertension (mean age 57.5 yr) were randomized and treated with acarbose (A, insulin-lowering, 3×100 mg) or gliben-clamide (G, insulin-enhancing, mean dose 5.1 mg) to compare the long-term blood pressure (BP) profile. Except for intervention by lifestyle modification no antihypertensive therapy was permitted. BP was assessed by 24h monitoring before therapy, after 3 and 6 mo. Laboratory data on glycemic control, lipids and safety were collected. All patients entered ITT analysis, 63 (A: 32; G: 31) entered the per-protocol-analysis. The mean duration of diabetes and hypertension was 20.2 ± 31.2 (A)/30.1 ± 37.0 (G) mo and 35.6 ± 44.8 (A)/31.2 ± 35.4 (G) mo respectively. The weighted 24h systolic and diastolic mean values (mmHg) were 134.9 ± 11.6 (A)/138.5 ± 14.1 (G) and 84.2 ± 6.2 (A)/85.9 ± 6.2 (G) respectively. Fasting insulin level (>/< 15 mU/I) stratification showed higher systolic 24h BP (+4.5 ± 0.21 mmHg) in the >15 mU/I group, in particular during the day (7 a.m. to 10 p.m.: +5.8 ± 0.11; not statistically significant [p=0.11]). Insulin levels (mU/I) were lower in group A (fasting: A: 14.8 ± 8.5; G: 20.5 ± 17.9; p<0.05; postprandial: A: 49.3 ± 40.6; G: 61.6 ± 54.8; p<0.05). Change of systolic 24h BP (mmHg) over 24 wk was −5.2 ± 2.4 under A (G: −1.6 ± 2.4) (p=0.0001), whereas change of diastolic 24h BP (mmHg) over 24 wk was −5.5 ± 1.5 under G (A: −2.4 ± 1.5) (p=0.0001). Body weight de-creased under A (−6.6 ± 2.5 kg) and increased under G (+3.8 ± 3.1 kg). HbA1c improved slightly more under A (7.0 ± 1.4⇒6.5 ± 1.2; G: 7.2 ± 1.7 ⇒ 7.0 ± 1.6). Different antidiabetics may influence BP in different ways. Conceivably A is useful in the lifestyle modification of type 2 diabetes patients and primarily isolated systolic hypertension.