Pathophysiology of Antihypertensive Therapy with Diuretics

Effects of Manidipine/Delapril versus Olmesartan/Hydrochlorothiazide Combination Therapy in Elderly Hypertensive Patients with Type 2 Diabetes Mellitus

“…Potassium depletion may play a role in glucose intolerance by inhibiting the conversion of pro-insulin to insulin (44). The reduction in doses of thiazides that has taken place over the last several years has had a significant impact in reducing diuretic metabolic complications (49,50). Moreover, these undesirable adverse effects of thiazides may be lessened by combination with ARBs (51,52).…”

Urinary Albumin Excretion During Angiotensin II Receptor Blockade: Comparison of Combination Treatment With a Diuretic or a Calcium-Channel Blocker

“…These results might be explained by the fact that thiazide diuretics reduced UAE through the decrease of glomerular capillary pressure and enhanced nocturnal BP decline. [6][7][8] On the other hand, it has been demonstrated that the RAS inhibitor/CCB combination decreased oxidative stress, inflammation, and insulin resistance, which have been reported…”

Combination of an ACE Inhibitor and Indapamide Improves Blood Pressure Control, but Attenuates the Beneficial Effects of ACE Inhibition on Plasma Adiponectin in Patients With Essential Hypertension

“…27 As BP goes down, the glomerular capillary pressure drops and glomerular filtration rate decreases, leading to activation of the RAS. 28 Simultaneous administration of ACEIs could then promote the natriuretic and hypotensive effects of the diuretics. Besides, blockade of the RAS with either an ACEI or an angiotensin II receptor blocker may cause a substantial increase in the adiponectin level and improved insulin sensitivity.…”