| Spironolactone for poorly controlled hypertension in type 2 diabetes: conflicting effects on blood pressure, endothelial function, glycaemic control and hormonal profiles. | |
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MedLine Citation:
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PMID: 18347776 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS/HYPOTHESIS: Aldosterone antagonism improves endothelial function (and reduces deaths) in chronic heart failure. It is not known whether similar effects occur in other high-risk groups such as patients with diabetes and hypertension. We therefore assessed the full effects of aldosterone blockade in poorly controlled hypertensive patients with type 2 diabetes, focussing on blood pressure, endothelial function, glycaemic control and key hormones. METHODS: We performed a randomised, placebo-controlled, double-blind, crossover study on 50 patients with type 2 diabetes and treated but poorly controlled hypertension, comparing spironolactone versus placebo. Patients had their endothelial function assessed by standard forearm venous occlusion plethysmography. RESULTS: There was no significant improvement in endothelium-dependent vasodilatation in response to acetylcholine, despite highly significant reductions in systolic and diastolic blood pressure. However, spironolactone significantly worsened glycaemic control, plasma angiotensin II and cortisol. CONCLUSIONS/INTERPRETATION: Spironolactone is highly effective in lowering blood pressure in patients with type 2 diabetes and poorly controlled hypertension on standard treatment, but does not improve vascular endothelial function in this group. We speculate that any tendency for the spironolactone-induced lowering of blood pressure to improve endothelial function is offset by its tendency to worsen glycaemic control and increase the levels of angiotensin II and even possibly cortisol. |
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Authors:
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K Swaminathan; J Davies; J George; N S Rajendra; A D Morris; A D Struthers |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2008-03-18 |
Journal Detail:
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Title: Diabetologia Volume: 51 ISSN: 0012-186X ISO Abbreviation: Diabetologia Publication Date: 2008 May |
Date Detail:
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Created Date: 2008-04-08 Completed Date: 2008-08-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0006777 Medline TA: Diabetologia Country: Germany |
Other Details:
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Languages: eng Pagination: 762-8 Citation Subset: IM |
Affiliation:
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Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK. krishnan.swaminathan@nhs.net |
| Data Bank Information | |
Bank Name/Acc. No.:
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ISRCTN/ISRCTN76558770 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aldosterone / blood Angiotensin II / blood Blood Glucose / drug effects, metabolism Blood Pressure / drug effects* Body Mass Index Cross-Over Studies Diabetes Mellitus, Type 2 / complications* Diabetic Angiopathies / drug therapy* Double-Blind Method Endothelium, Vascular / drug effects, physiopathology* Female Fibroblast Growth Factors / blood Hemoglobin A, Glycosylated / metabolism Humans Hydrocortisone / blood Hypertension / drug therapy* Male Middle Aged Natriuretic Peptide, Brain / blood |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose; 0/Hemoglobin A, Glycosylated; 11128-99-7/Angiotensin II; 114471-18-0/Natriuretic Peptide, Brain; 50-23-7/Hydrocortisone; 52-39-1/Aldosterone; 62031-54-3/Fibroblast Growth Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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