Anti hypertensive therapy with verapamil SR plus trandolapril versus atenolol plus chlorthalidone on glycemic control

被引:48
作者
Holzgreve, H
Nakov, R
Beck, K
Lanka, HU
机构
[1] Univ Munich, Med Poliklin, Munich, Germany
[2] Knoll AG, Dept Clin Cardiol, Ludwigshafen, Germany
[3] Zentralkrankenhaus Bremen Nord, Bremen, Germany
关键词
hypertension; antihypertensvie agents; glucose intolerance; type; 2; diabetes; hemoglobin A(1c);
D O I
10.1016/S0895-7061(03)00062-1
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Background: There is evidence that diuretics and beta blockers impair glucose tolerance, whereas calcium channel blockers and angiotensin converting enzyme blockers lack this metabolic effect. We compared the effect of a combination therapy with a nondihydropyridine calcium channel blocker plus an angiotensin converting enzyme inhibitor and a beta blocker plus a diuretic on hemoglobin A(1C) (Hb A(1C)) in patients with type 2 diabetes and mild-to-moderate hypertension. Methods: A total of 463 hypertensive outpatients with non-insulin treated type 2 diabetes on stable antidiabetic therapy for at least 3 months and with HbA(1C) between 6.5% and 10% were recruited. In a randomized, double blind trial patients were treated for 20 weeks with fixed combinations of verapamil sustained release (SR) plus trandolapril and of atenolol plus chlorthalidone following a 2-week placebo run-in period. The main outcome measures were HbA(1C), fasting, plasma glucose, and fructosamine levels as well as systolic and diastolic blood pressure. Results: HbA(1C) remained stable at 7.9% after administration of verapamil SR plus trandolapril and increased from 7.8% to 8.6% with atenolol plus chlorthalidone; the differences between treatment groups were significant at 4, 12, and 20 weeks of treatment and at last visit (P < .0001). Mean blood pressure fell from 169/96 to 150/85 and from 168/95 to 145/83 mm Hg after administration of verapamil SR plus trandolapril and atenolol plus chlorthalidone, respectively. Both combinations were well tolerated. Conclusions: HbA(1C) and other parameters of short-and long-term glycemic control were in a more favorable range after antihypertensive treatment with verapamil SR plus trandolapril as compared with atenolol plus chlorthalidone. (C) 2003 American Journal of Hypertension, Ltd.
引用
收藏
页码:381 / 386
页数:6
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