Effect of Chronic ACE Inhibition on Glucose Tolerance and Insulin Sensitivity in Hypertensive Type 2 Diabetic Patients

Abstract

The question, of whether long-term treatment of essential hypertension with angiotensin-converting enzyme (ACE) inhibitors is capable of modifying glucose tolerance or insulin sensitivity in Type 2 (non-insulin dependent) diabetes, is still unsolved. We studied 14 moderately overweight Type 2 diabetic patients with essential hypertension in stable metabolic control after a run-in period and again after 3 months of antihypertensive treatment with the ACE inhibitor, captopril. Glucose tolerance was tested with a 75-g oral glucose load and insulin sensitivity was measured by the insulin suppression test, while dietary and drug treatment of the diabetes remained constant. In the whole group, mean blood pressure (MBP) fell progressively over 3 months from a baseline value of 123 +/- 3 mmHg to a final value of 115 +/- 2 mmHg (p < 0.005); in six patients, the change in MBP was < 5 mmHg (non-responders), thus giving a clinical response rate of approximately 60%. After treatment, fasting plasma glucose, insulin, free fatty acid (FFA), potassium, and glycated haemoglobin concentrations were unchanged from baseline. During the oral glucose tolerance test, the incremental glucose area-under-curve was 0.75 +/- 0.05 mol 120 min l-1 before and 0.76 +/- 0.06 mol 120 min l-1 after treatment (p = ns). Endogenous insulin response and suppression of plasma FFA levels were superimposable on the two occasions. During the insulin suppression test, steady-state plasma glucose levels were 14.4 +/- 1.3 vs 14.2 +/- 1.1 mmol l-1 before and after chronic ACE inhibition, respectively, at comparable hyperinsulinaemic plateaux (291 +/- 21 vs 287 +/- 14 pmol l-1).(ABSTRACT TRUNCATED AT 250 WORDS)

Effectiveness and metabolic effects of perindopril and diuretics combination in primary hypertension

“…Thus, the putative beneficial effect of ACE inhibitors on carbohydrate metabolism remains controversial. [26][27][28][29] It is possible that the impact on sensitivity to insulin varies with different ACE inhibitors, 30 and it is dependent on the degree of underlying insulin resistance. If subjects are not particularly insulin resistant, as was the case in our patients, then it may be more difficult to reveal a beneficial effect.…”

Antihypertensive agents, insulin sensitivity, and new-onset diabetes

“…Cilazapril was also shown to significantly improve IS estimated with the insulinogenic index [33] or a modified insulin suppression test [34], and fosinopril was found to significantly decrease the HOMA-IR index in hypertensive patients [35]. In other cases, captopril [36], enalapril [30,37,38], and trandolapril [39] were not found to significantly change IS, but some of these studies could be limited by small sample sizes and the relevant findings should be interpreted carefully, as mentioned above [31]. Overall, it seems that ACE inhibitors have a positive, or at least neutral, effect on IS.…”

The Renin Angiotensin System and the Metabolic Syndrome~!2010-02-12~!2010-04-19~!2010-06-25~!

“…Clinical studies indicate that ARBs and ACE inhibitors prevent the onset of diabetes and improve insulin sensitivity [152,153]. In mice, blocking AT1R improves insulin sensitivity and other diabetes symptoms due to increased glucose uptake in skeletal muscle and white adipose tissue [154].…”