How can we block sympathetic overactivity? Effects of rilmenidine and atenolol in overweight hypertensive patients

Abstract

The aim of the present study was to evaluate effects of long-term treatment with rilmenidine compared with atenolol on lipid and glucose metabolism and cardiovascular remodelling in hypertension. In total, 37 patients with hypertension were randomised to rilmenidine 1-2 mg/day or atenolol 50-100 mg/day for 26 weeks. Standard oral glucose tolerance test with a parallel measurement of insulin and glucose levels was performed. The 'areas under the curve' (AUC) for insulin and glucose were calculated. Plasma lipids, left ventricular mass index (LVMI), and intima-media thickness (IMT) were measured. Brachial artery diameter during reactive hyperaemia was used to test endotheliumdependent vasodilatation (EDVD). Blood pressure reduction was equally achieved in both treatment arms. The fasting glucose level increased in the atenolol group from 4.870.6 to 5.270.7 mmol/l (Po0.01). The AUC of glucose in rilmenidine group decreased from 860793 to 737766 mmol/min/l (Po0.05), and in the atenolol group it increased from 937786 to 989788 mmol/min/l (Po0.05). Rilmenidine showed a positive effect on lipid levels, whereas in the atenolol group a significant decrease of high-density lipoprotein cholesterol was observed. Left ventricular mass index decreased with rilmenidine by 9.6% and by 6.9% with atenolol (Po0.05). Intima-media thickness significantly decreased in the rilmenidine group. Endothelium-dependent vasodilatation slightly increased on in the rilmenidine group, while on in the atenolol group it remained unchanged. Our data suggest that in hypertensive patients central inhibition of sympathetic drive can produce favourable effects on glucose and lipid metabolism compared with standard b-blockade with a similar antihypertensive efficacy. Rilmenidine also provides beneficial effects on cardiovascular remodelling and altered endothelial function in hypertension.

Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects

“…A block randomization method with block sizes of 4 and 6 was used for participant randomization. The area under the curve for glucose and insulin were calculated according to Seltzer’s methods as published elsewhere [18,19]. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated as follows: fasting insulin (μU/ml) × fasting glucose (mg/dl) ÷ 450.…”

Blood pressure lowering effects of non-surgical procedures for vascular decompression: good news to be taken with caution

“…[14][15] Other relationships to adrenergic function, such as age, heredity, concomitant drug therapies and so on, will also need to be considered in any study. [16][17][18] In conclusion, the study by Bakris et al provides new interesting information on the favourable blood pressure lowering effects of microvascular decompression caused by chiropractic procedure. Before recommending this therapeutic strategy in the current clinical practice, however, it seems reasonable to wait for the results of large-scale clinical trials aimed at defining the long-term effects of the intention on clinic and ambulatory blood pressure as well as on some surrogate end points, such as cardiac and vascular target organ damage.…”

Centrally acting antihypertensives change the psychogenic cardiovascular reactivity

“…From the available therapeutic arsenal to treat sympathetic overactivity-linked hypertension [22], the centrally acting antihypertensive drugs capable of reducing autonomic imbalance seem preferable. Clonidine (CL) and Rilmenidine (RI) are among the most prescribed centrally acting sympatholytic molecules [23][24][25].…”