Beneficial Effects of Angiotensin-Converting Enzyme Inhibitor on Renal Function and Glucose Homeostasis in Diabetics with Hypertension

Abstract

The antihypertensive efficacy of enalapril and its effects on renal function and glucose homeostasis were investigated in 9 hypertensive patients with non-insulin-dependent diabetes mellitus. Enalapril therapy produced a significant fall in blood pressure (BP) (p < 0.05) and a significant increase in renal blood flow (p < 0.05) without a change in glomerular filtration rate. Furthermore, fasting plasma glucose was significantly reduced (p < 0.01). Similarly, M value, as an index of plasma glucose control in diabetes, was significantly reduced from 19.6 to 10.1 (p < 0.01). These findings suggested that the angiotensin-converting enzyme inhibitor enalapril was effective in reducing BP and improving renal function, and might improve glucose homeostasis in hypertensive diabetics.

Comparison of enalapril and nifedipine in treating non-insulin dependent diabetes associated with hypertension: one year analysis.

“…(27) 15 (30) Body mass index (kg/m2)24 8 (3 0)25 2 (2 9) test was used to compare the rates of conversion from Supine blood pressure (mm Hg) 166/91 (16/9) 174/92 (17/13) normoalbuminuria to abnormal albuminuria between Erect blood pressure (mm Hg) 167/94 (16/12) 171/94 (19/14)Mean arterial blood pressure (mm Hg) 117 (9) 120(12) the treatment groups. Repeated measures analysis of Glycatedhaemoglobin (%/)9 8 (1-7) (1 7)variance was used to test for the effects of treatmentPlasma fructosamine (mmol/l) 2 3 (0Q23) 2 3 (0-23)Fasting plasma glucose(mmol/l) 80 (21) 83(25) and its duration.…”

Effects of inhibition of the renin‐angiotensin system on the cardiovascular actions of insulin

“…More importantly, there may be a difference between the effects of hyperinsulinaemia and insulin resistance in the development of hypertension. It has been well documented that people with essential hypertension, but not secondary hypertension[50], are more likely to suffer from insulin resistance and hyperinsulinaemia[1–7,30–51]. Similarly, hypertension is prevalent in NIDDM and obese patients, conditions that also are associated with various degrees of insulin resistance.…”

“…It appears that the effect of insulin on SNS activity is direct and not simply baroreceptor mediated[54]. Insulin does not appear to cause mass activation of SNS activity but increases selective nerve activity[18–54]. The brain areas that have been associated with insulin's activation of sympathetic activity[54] are also the sites of the central pressor actions of Ang II[55].…”

“…There are numerous reports that suggest an interrelationship between insulin and the RAS[20–28,33–46]. It has been hypothesized that angiotensin may play a role in inducing insulin resistance[47–48].…”

Comparison of effects of quinapril and metoprolol on glycaemic control, serum lipids, blood pressure, albuminuria and quality of life in non‐insulin‐dependent diabetes mellitus patients with hypertension

“…In line with these findings, severe hypoglycaemic episodes have occurred only a few hours or days after starting treatment with an ACE inhibitor [ 13, 14]. However, a large number of clinical studies, usually uncontrolled, brief and covering few patients [ 15, 16], have found that ACE treatment had no significant effect on glycaemic control in NIDDM or on insulin and C‐peptide levels [ 17] and only a few have indicated an improvement, with reduction in fasting blood glucose [ 18] or glycosylated haemoglobin (HbA 1c ) [ 19, 20].…”