[Effect of combination antihypertensive therapy on circadian blood pressure and metabolic parameters in patients with type 2 diabetes mellitus].

AIM

To assess effect of combined antihypertensive therapy with lisinopril and amlodipine on circadian blood pressure (BP), insulin resistance (IR), carbohydrate and lipid metabolism in patients with arterial hypertension (AH) and type 2 diabetes mellitus (DM).

MATERIAL AND METHODS

Combination of amlodipine (6.0±0.4 mg/day) and lisinopril (12.0±0.9 mg/day) was given to 30 patients (age 40-65 years) with stage I-II AH and DM type 2) for 24 weeks. All patients underwent ambulatory BP monitoring. Parameter studied comprised glucose levels, glycosylated hemoglobin (HbAlc), basal insulin, lipid profile in the venous blood and insulin resistance (IR). All patients received glucose-lowering drugs and followed diet recommendations.

RESULTS

All patients achieved target BP values and concentrations of HbAlc. After 24 weeks of treatment the following parameters were significantly different from baseline values: mean systolic BP (SBP) (-15.6%), mean diastolic BP (DBP), (-16.2%), time index (pressure load--PL) SBP day (-50.1%), PL DBP day (-51.3), PL DBP night (-59.2%), SBP variability (-15.8%), values of morning SBP and DBP increase (both -41.8%), rates of morning rise of SBP (-74.1%) and DBP (-65.8%), percentage of patients with increased variability of SBP (-36.7%), of DBP (- 23.3%), of SBP day (-36.7%), of DBP day (-30.0%). Significant decreases of fasting blood glucose level (-22.1%), concentrations of total cholesterol (-8.8%), low density lipoprotein cholesterol (-15%), triglycerides (-4.4%), and metabolic index (-32.7%) were also observed.

CONCLUSION

In patients with hypertension and type 2 DM 24 week antihypertensive therapy with lisinopril and amlodipine significantly improved circadian blood pressure profile, reduced severity of IR without negative effect on carbohydrate and lipid metabolism.