A Prospective Comparative Study of Effect of Telmisartan Plus Diet and Exercise Versus Telmisartan and Metformin on Metabolic Parameters in Hypertensive Patients With the Metabolic Syndrome

Abstract

BACKGROUND Metabolic syndrome is a group of disorders characterised by hyperglycaemia, central obesity and hypertension and dyslipidaemia. This is a condition which is advocated with increased risk of CVD and diabetes mellitus. It is a major modifiable condition that can be prevented and premature death can be decreased. MATERIALS AND METHODS Present study is designed to study the defect of telmisartan with diet and exercise versus telmisartan and metformin on various metabolic parameters in metabolic syndrome patients with hypertension. All the metabolic parameters fasting plasma glucose, insulin (fasting), total cholesterol, LDL-cholesterol, triglyceride, C-peptide Blood pressure, BMI and HOMA-IR were measured at the start of the study and was followed regularly. Final measurements of all these parameters were done after 6 months. Hexokinase method was used for estimation of plasma glucose. RESULTS Weight of the patient in group A was decreased from 89.52 yrs. to 79.6 yrs. after 6 months, in group B it was decreased from 86.52 kg to 84.56 kg, similarly body mass index (BMI) was reduced in group A from 30.4 kg/m 2 to 27.5 kg/m 2 and in group B it was reduced from 30.1 kg/m 2 to 29.4 kg/m 2. Fasting plasma glucose was 97.79 mg/dL in group A at the start of the study, after 6 months it reduced to 92.76 mg/dL. In group B the fasting plasma glucose was decreased from 96.86 mg/dL to 89.40 mg/dL. Fasting plasma insulin level has been reduced from 12.21 mIU/L to 10.21 mIU/L in group A and from 12.55 to 9.51 mIU/L in group B. HOMA-IR which was 2.96 in group A was reduced to 2.89 and in group B reduced from 3.03 to 2.82. CONCLUSION In our study, we have found that the decrease in weight and body mass index was more in group A than group B percentage change in mean of weight was 12.46% in group A and 4.57% in group B, similarly in BMI was 9.5% and 3.9% respectively. We have found that percentage change in mean of FPG, HbA1C and FPI was more in group B and also the change in HOMA-IR. Before start of the study, basal FPI was more but after six months it decreased, but plasma glucose concentration also decreased that indicates that sensitivity of insulin increased. Diet and exercise has good effect on serum triglyceride and LDL-C, but metformin has good effect on HDL-C and total cholesterol.