Comparison of the hemodynamic and metabolic effects of low-dose hydrochlorothiazide and lisinopril treatment in obese patients with high blood pressure

Abstract

Patients with high blood pressure tend to be insulin resistant, glucose intolerant, hyperinsulinemic, and dyslipidemic. Since these metabolic defects are accentuated by obesity, we thought it important to compare the effects of 3 months' treatment with either lisinopril (20 mg/day) or low dose hydrochlorothiazide (12.5 mg/day) on blood pressure and glucose, insulin, and lipoprotein metabolism in obese patients with hypertension. There were 14 patients in each group, and they were similar (mean +/- SE) in age (54 +/- 3 v 50 +/- 4 years), gender (nine men/five women), and body mass index (33.4 +/- 0.8 v 33.9 +/- 0.9 kg/m2). Patients treated with lisinopril had a somewhat greater fall in both systolic (18 +/- 3 v 10 +/- 3 mm Hg) and diastolic (12 +/- 2 v 8 +/- 1 mm Hg) blood pressure, but only the change in systolic pressure was statistically significant (P < .05). Plasma glucose, insulin, and triglyceride concentrations were measured at hourly intervals from 8 AM to 4 PM (breakfast at 8 AM and lunch at 12 PM), and there was a modest increase in all three variables following hydrochlorothiazide treatment (P < .05 to P < .09). However, daylong plasma glucose, insulin, and triglyceride concentration did not change with lisinopril treatment. Finally, neither the ability of insulin to mediate glucose disposal nor fasting lipid and lipoprotein concentrations, changed with either treatment. In conclusion blood pressure decreased significantly following treatment with either lisinopril (20 mg/day) or hydrochlorothiazide (12.5 mg/day).(ABSTRACT TRUNCATED AT 250 WORDS)

Managing Hypertension in Patients with Diabetes

“…In patients on thiazides, hypokalemia has been associated with higher FBG that improved after replacement of potassium [54]. Thiazide diuretics may impair glucose metabolism by decreasing peripheral insulin sensitivity, resulting in increasing insulin secretion [55][56][57]. Our results suggest that the probability of developing new diabetes after thiazide initiation is associated with increasing BMI [48].…”

Effect of short-term ACE inhibitor treatment on peripheral insulin sensitivity in obese insulin-resistant subjects

“…However, many studies have shown that ACE inhibition has no beneficial effects on insulin sensitivity and the development of diabetes (Table 1) [15][16][17][18][19][20][21][22][23][24]. Unfortunately, several investigations on this issue are based on uncontrolled study designs and surrogate markers of insulin sensitivity, and are potentially confounded by the use of additional medication.…”

Effect of Valsartan Addition to Amlodipine on Insulin Sensitivity in Overweight-Obese Hypertensive Patients

“…Most data from the literature indicate that diuretics and beta-blockers reduce insulin sensitivity and increase lipid levels (11,12); calcium channel blockers (CCB) are generally considered to be metabolically neutral (13), although some studies have indicated a positive impact on insulin sensitivity (14,15) (11,12,(16)(17)(18) …”