Acta Diabetologica

, Volume 32, Issue 3, pp 203–208 | Cite as

Hypertension and non-insulin-dependent diabetes

A comparison between an angiotensin-converting enzyme inhibitor and a calcium antagonist
  • G. Crepaldi
  • A. Carraro
  • E. Brocco
  • L. Adezati
  • D. Andreani
  • G. Bompiani
  • P. Brunetti
  • D. Fedele
  • R. Giorgino
  • G. Giustina
  • G. Menzinger
  • R. Navalesi
  • G. Pagano
  • A. Tiengo
  • G. Villa
  • R. Nosadini
Originals
Received:
Accepted:

Abstract

The effects of the angiotensin-converting enzyme lisinopril were compared with those of the calcium antagonist nifedipine in 162 non-insulin-dependent diabetic hypertensive patients for a 24-week period. In 83 and 79 patients, respectively, lisinopril and slow-release nifedipine produced similar reductions in blood pressure (systolic/diastolic: −16/−13 mmHg supine and −14/−11 mmHg standing after lisinopril; −15/−12 mmHg supine and −14/−11 mmHg standing after nifedipine). Fasting and post-prandial plasma glucose, glycosylated haemoglobin and plasma lipids appeared to be unaffected by either agent. Also, 28% of the patients on lisinopril and 30% of those on nifedipine presented microalbuminuria. Both drugs induced a reduction in the albumin excretion rate (AER). The geometric meanxx: tolerance factor of the reduction in AER among the 23 microalbuminuric patients on lisinopril (−10.0xx:1.3 μg/min) was greater, though not significantly so, than that observed in the 26 on nifedipine (−0.9x:1.2 μg/min). Moreover, lisinopril appeared to be better tolerated than nifedipine in our study population. Microalbuminuria is an important risk factor for cardiovascular mortality in non-insulin-dependent diabetic patients as well as in the general population. To what extent a reduction in the AER could ameliorate the cardiovascular prognosis in non-insulin-dependent diabetic patients is, at present, unknown. Finally, both lisinopril and nifedipine showed a similar antihypertensive effect in these patients which was not associated with significant differences in plasma glucose, insulin or lipid concentrations. The clinical consequences of the insignificant differences in AER remain unclear.

Key words

Hypertension Non-insulin-dependent diabetes Microalbuminuria Lisinopril Nifedipine 
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Houston MC, Treatment of hypertension in diabetes mellitus. Am Heart J 118:819–829, 1989CrossRefPubMedGoogle Scholar
  2. 2.
    Tuck M, Management of hypertension in the patient with diabetes mellitus. Focus on the use of angiotensin-converting enzyme inhibitors. Am J Hypertens 1:384s-388s, 1988PubMedGoogle Scholar
  3. 3.
    Simonson DC, Insulin sensitivity and the effects of antihypertensive agents: implications for the treatment of hypertension in patients with diabetes mellitus. Postgrad Med J 64 (Suppl 3):39–49, 1988PubMedGoogle Scholar
  4. 4.
    Hedner T, Samuelsson O, Lindholm L, Effects of hypertensive therapy on glucose tolerance: focus on calcium antagonists. J Intern Med (Suppl 735):101–111, 1991Google Scholar
  5. 5.
    Brichard SM, Santoni JP, Thomas JR, Van De Voorde K, Ketelslegers JM, Lambert AE, Long term reduction of microalbuminuria after 1 year of angiotensin-converting enzyme inhibition by perindopril in hypertensive insulin-treated hypertensive patients. Diabete Metabol 16:30–36, 1989Google Scholar
  6. 6.
    Sorkin EM, Clissold SP, Brogden RN, Nifedipine: a review of its pharmacodynamic and pharmacokinetic properties and therapy efficacy in ischemic heart disease, hypertension and related cardiovascular disorders. Drugs 30:182–274, 1985PubMedGoogle Scholar
  7. 7.
    Kostis JB, Angiotensin converting enzyme inhibitors. 1.Pharmacology. Am Heart J 116:1580–1591, 1988CrossRefPubMedGoogle Scholar
  8. 8.
    Dunn PJ, Cole RE, Soeldner JS, Further development and automation of a high pressure liquid chromatography method for the determination of glycosylated haemoglobins. Metabolism 28:777–779, 1975CrossRefGoogle Scholar
  9. 9.
    Care RN, Feldbruegger D, Westgard J, Evaluation of the adaptation of the glucose peroxide 3-methyl-2-benzothiazolinone hydrazone-N-N dimethyline procedure to the technicon “SMA” 12/60 and comparison with other automated methods of glucose. Clin Chem 20:595–602, 1974PubMedGoogle Scholar
  10. 10.
    Heding LG, Radioimmunological determination of human C peptide in serum. Diabetologia 11: 541–548, 1975CrossRefPubMedGoogle Scholar
  11. 11.
    Wahlefeld AW, Triglyceride determination after enzymatic hydrolysis. In: Bergemeyer HU (ed) Methoden der enzymatischen Analyse, 3rd edn, Vol 2. Verlag Chemie, Weinheim, pp 1878–1882, 1974Google Scholar
  12. 12.
    Burnstein M, Scholnick HR, Lipoprotein-polyanion-metal interactions. Adv Lipid Res 11:67–108, 1973PubMedGoogle Scholar
  13. 13.
    Scidel J, Schlumberger S, Klose J, Ziegenhorn F, Wahlefeld AW, Improved reagent for the enzymatic determination. J Clin Chem Biochem 19:838–844, 1981Google Scholar
  14. 14.
    Keen H, Chlouverakis G, An immunoassay method for urinary albumin low concentrations. Lancet 2:913–914, 1963CrossRefGoogle Scholar
  15. 15.
    Jano T, Kawarmura T, Matsurmal H, Sasaki H, Nakayama M, Hara T, Matsuo S, Hotta N, Sakamoto N, Effects of long-term enalapril treatment on persistent microalbuminuria in well-controlled hypertensive and normotensive NIDDM patients. Diabetes Care 17:420–424, 1994PubMedGoogle Scholar
  16. 16.
    Bjorck S, Aurell M, Diabetes mellitus, the renin-angiotensin system, and angiotensin-converting enzyme inhibition. Nephron 55 (Suppl 1):10–20, 1990Google Scholar
  17. 17.
    Nielsen S, Schmitz A, Rehling M, Mogensen CE, Systolic blood pressure relates to the rate of decline of glomerular filtration rate in Type II diabetes mellitus. Diabetes Care 16:1427–1432, 1993PubMedGoogle Scholar
  18. 18.
    Fuller JH, Shipley MJ, Rose G, Jarret RJ, Keen H, Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the Whitehall Study. Br Med J 287:867–870, 1983Google Scholar
  19. 19.
    Christlieb AR, Warram JH, Krolewski AS, Busick EJ, Ganda OP, Asmal AC, Soeldner JS, Bradley RF, Hypertension: the major risk factor in juvenile onset insulin dependent diabetics. Diabetes 30 (Suppl 2):90–96, 1981PubMedGoogle Scholar
  20. 20.
    Knowler WC, Bennett PH, Ballantine EJ, Increased incidence of retinopathy in diabetics with elevated blood pressure. N Engl J Med 302:645–650, 1980PubMedGoogle Scholar
  21. 21.
    Collins R, Peto R, MacMaron S, hebert P, Fieback N, Eberlein K, Godwin J, Qizibbash N, Taylor J, Hennekens CH, Blood pressure, stroke and coronary heart disease. Part 2. Short term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 335: 827–838, 1990PubMedGoogle Scholar
  22. 22.
    O'Hare JP, Anderson JV, Miller ND, Bloom SR, Corral R JM, The relationship of the renin-angiotensin-aldosterone system to atrial natriuretic peptide and the natriuresis of volume expansion in diabetics with and without proteinuria. Postgrad Med J 64 (Suppl 3):35–38, 1988Google Scholar
  23. 23.
    Gall Ma, Nielsen FS, Smidt UM, Parving H-H, The course of kidney function in Type 2 (non-insulin-dependent) diabetic patients with diabetic nephropathy. Diabetologia 36:1071–1078, 1993PubMedGoogle Scholar
  24. 24.
    Tsalamandris C, Allen JJ, Gilbert RE, Sinha A, Panagiotopoulis S, Cooper ME, Jerums G, Progressive decline in renal function in diabetic patients with and without albuminuria. Diabetes 43:649–656, 1994PubMedGoogle Scholar
  25. 25.
    Baba T, Murabayashi S, Takabe K, Comparison of the renal effects of angiotensin converting enzyme inhibitor and calcium antagonist in hypertensive type II (non-insulin-dependent) diabetic patients with microalbuminuria: a randomized controlled trial. Diabetologia 32:40–44, 1989PubMedGoogle Scholar
  26. 26.
    Jerums G, Allen TJ, Tsalmandris C, Cooper ME forthe Melbourne Diabetic Nephropathy Study Group, Angiotensin converting enzyme inhibition and calcium channel blockade in incipient diabetic nephropathy. Kidney Int 41:904–911, 1992PubMedGoogle Scholar
  27. 27.
    Remuzzi G, Bertani T, Is glomerulosclerosis a consequence of altered glomerular permeability to macromolecules? Kidney Int 38:384–394, 1990PubMedGoogle Scholar
  28. 28.
    Melbourne Diabetic Nephropathy Study Group, Comparison between perindoprial and nifedipine in hypertensive and normotensive diabetic patients with microalbuminuria. Br Med J 302:210–216, 1991Google Scholar
  29. 29.
    Lacourciere Y, Nadeau A, Poirier L, Taucrede G, Captopril or conventional therapy in hypertensive Type I diabetics. Threeyear analysis. Hypertension 21:786–794, 1993PubMedGoogle Scholar
  30. 30.
    Ravid M, Savin H, Jutrin I, Bental T, Katz B, Lishner M, Longterm stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive Type II diabetic patients. Ann Intern Med 118:577–581, 1993PubMedGoogle Scholar
  31. 31.
    Koffler M, Ramirez LC, Raskin P, The effects of many commonly used drugs on diabetic control. Diab Nutr Metab 2:75–93, 1989Google Scholar
  32. 32.
    Holdaas H, Hartmann A, Lien MG, Nilsen L, Fauchald P, Jervell J, Berg KJ, Contrasting effect of lisinopril and nifedipine on albuminuria and tubular transport functions in insulin dependent diabetics with nephropathy. J Intern Med 229:163–170, 1991PubMedGoogle Scholar
  33. 33.
    Mörlin C, Baglivo H, Boeijinga JK et al. Comparative trial of lisinopril and nifedipine in mild to essential hypertension. J Cardiovasc Pharmacol 9 (Suppl 3):S48-S52, 1987Google Scholar
  34. 34.
    Witchitz S, Serradimigni A, Lisinopril versus slow-release nifedipine in the treatment of mild to moderate hypertension: a multicentre study. J Hum Hypertens 3:29–33, 1989Google Scholar
  35. 35.
    Os I, Bratland B, Dahloef B, Gisholt K, Syvertsen JO, Tretil S, Lisinopril or nifedipine in essential hypertension? A Norwegian multicentre study on efficacy, tolerability and quality of life in 828 patients. J Hypertens 9:1097–1104, 1991PubMedGoogle Scholar
  36. 36.
    Schnack CH, Capek M, Banyai M, Kautzky-Willer A, Prager B, Schernthauer G, Long term treatment with nifedipine reduces urinary albumin excretion and glomerular filtration rate in normotensive Type I diabetic patients with microalbuminuria. Acta Diabetol 31:14–18, 1994PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • G. Crepaldi
    • 1
  • A. Carraro
    • 1
  • E. Brocco
    • 1
  • L. Adezati
    • 1
  • D. Andreani
    • 1
  • G. Bompiani
    • 1
  • P. Brunetti
    • 1
  • D. Fedele
    • 1
  • R. Giorgino
    • 1
  • G. Giustina
    • 1
  • G. Menzinger
    • 1
  • R. Navalesi
    • 1
  • G. Pagano
    • 1
  • A. Tiengo
    • 1
  • G. Villa
    • 2
  • R. Nosadini
    • 1
  1. 1.Department of Internal MedicineUniversity HospitalPaduaItaly
  2. 2.ZenecaMilanItaly

Personalised recommendations