Document Detail


Effect of delapril/manidipine vs olmesartan/ hydrochlorothiazide combination on insulin sensitivity and fibrinogen in obese hypertensive patients.
MedLine Citation:
PMID:  18310964     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To compare the effect of delapril/manidipine vs olmesartan/hydrochlorothiazide (HCTZ) combination on insulin sensitivity and plasma fibrinogen in obese hypertensive patients. PATIENTS AND METHODS: After a 4-week placebo period, 88 obese, hypertensive (DBP >95 and <110 mmHg) outpatients were randomized to delapril 30 mg/manidipine 10 mg combination or to olmesartan 20 mg/HCTZ 12.5 mg combination for 24 weeks according to a prospective, randomized, open-label, blinded endpoint, parallel group design. At the end of the placebo period and treatment period, clinical BP, fasting plasma glucose (FPG), plasma insulin, insulin sensitivity (by euglycemic hyperinsulinemic clamp) and plasma fibrinogen were evaluated. Insulin sensitivity was expressed as the amount of glucose infused during the last 30 minutes (glucose infusion rate, GIR) in mg/Kg/min. The total glucose requirement (TGR) to maintain a steady-state blood glucose level in response to a defined increase in plasma insulin concentration was also evaluated. RESULTS: Both combinations significantly reduced SBP/DBP values (-22.3/16.4 mmHg and -22.6/17.2 mmHg, respectively, all p <0.001 vs placebo). GIR was significantly increased only by delapril/manidipine (+3.01 mg/min/Kg, p=0.038 vs placebo), the difference between treatments being significant (p <0.05). TGR was significantly increased by delapril/manidipine (+9.7 g, p=0.034), while it was unaffected by olmesartan/HCTZ. Plasma insulin as well as fibrinogen were significantly reduced by delapril/manidipine (-17.8 pmol/l, p=0.047 and -67.5 mg/dl, p=0.021, respectively), but not by olmesartan/HCTZ, the difference between the two treatments being statistically significant (p <0.05). CONCLUSION: In obese hypertensive patients the delapril/manidipine combination but not the olmesartan/HCTZ combination significantly decreased insulin resistance and plasma fibrinogen levels, despite the similar BP lowering efficacy.
Authors:
Roberto Fogari; Giuseppe Derosa; Annalisa Zoppi; Pierangelo Lazzari; Luca Corradi; Paola Preti; Amedeo Mugellini
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2008-03-03
Journal Detail:
Title:  Internal medicine (Tokyo, Japan)     Volume:  47     ISSN:  1349-7235     ISO Abbreviation:  Intern. Med.     Publication Date:  2008  
Date Detail:
Created Date:  2008-03-03     Completed Date:  2008-03-21     Revised Date:  2009-04-16    
Medline Journal Info:
Nlm Unique ID:  9204241     Medline TA:  Intern Med     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  361-6     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine and Therapeutics, Centro per l'Ipertensione e la Fisiopatologia Cardiovascolare, University of Pavia, Italy. r.fogari@unipv.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Angiotensin II Type 1 Receptor Blockers / pharmacology,  therapeutic use
Angiotensin-Converting Enzyme Inhibitors / pharmacology,  therapeutic use
Antihypertensive Agents / pharmacology*,  therapeutic use
Calcium Channel Blockers / pharmacology,  therapeutic use
Dihydropyridines / pharmacology,  therapeutic use
Drug Combinations
Female
Fibrinogen / drug effects*
Glucose Clamp Technique
Humans
Hydrochlorothiazide / pharmacology,  therapeutic use
Hypertension / complications,  drug therapy*
Imidazoles / pharmacology,  therapeutic use
Indans / pharmacology,  therapeutic use
Insulin Resistance*
Male
Middle Aged
Obesity / complications*
Tetrazoles / pharmacology,  therapeutic use
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Calcium Channel Blockers; 0/Dihydropyridines; 0/Drug Combinations; 0/Imidazoles; 0/Indans; 0/Tetrazoles; 0/olmesartan; 58-93-5/Hydrochlorothiazide; 83435-67-0/delapril; 89226-50-6/manidipine; 9001-32-5/Fibrinogen
Comments/Corrections
Comment In:
Intern Med. 2009;48(1):1-2   [PMID:  19122349 ]

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