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Insulin Resistance and Hypertension in the Elderly

Optimal Drug Therapy

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  • Drug Therapy
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Summary

Numerous trials have demonstrated the negative effects of some antihypertensive drugs upon glucose handling. Such findings seem particularly interesting in aged hypertensive patients who are also insulin resistant and affected by physiological changes in the renal and cardiovascular systems.

It appears that calcium channel blockers and angiotensin converting enzyme (ACE) inhibitors are the most appropriate drugs to lower blood pressure in aged insulin-resistant hypertensive patients. All calcium channel blockers studied have displayed similar metabolic effects, while among the ACE inhibitors studied, lisinopril was associated with the best metabolic responses. β-Blockers and thiazide diuretics have strong negative effects on glucose handling.

Further studies are needed in order to investigate the metabolic effects of α1-antagonists in aged patients with insulin resistance and hypertension.

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References

  • Amery A, Brixco P, Clement DL, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial. Lancet 1: 1349–1354, 1985

    Article  PubMed  CAS  Google Scholar 

  • Beretta-Piccoli C, Davies DL, Boddy K, et al. Relation of arterial blood pressure with body sodium, body potassium and plasma potassium in essential hypertension. Clinical Science 63: 257–260, 1982

    PubMed  CAS  Google Scholar 

  • Block HR. Therapeutic considerations in the elderly hypertensives: the role of calcium channel blockers. American Journal of Hypertension 3: 347S–354S, 1990

    Google Scholar 

  • Bühler FR, Multhen UL, Kiowski W, et al. Greater antihypertensive efficacy of the calcium channel inhibitor verapamil in older and low renin patients. Clinical Science 63(Suppl. 2): 439S–442S, 1982

    Google Scholar 

  • Bühler FR, Kiowski W. Age and antihypertensive response to calcium antagonist. Journal of Hypertension 5(Suppl. 4): 111S–114S, 1987

    Article  Google Scholar 

  • Clansen T, Elrink J, Morten BR. Insulin controlling calcium distribution in muscle and fat cells. Acta Endocrinologica 77: 137–143, 1974

    Google Scholar 

  • Dietze GJ. Modulation of the action of insulin in relation to the energy state in skeletal muscle. Possible involvement of kinins and prostaglandins. Molecular and Cellular Endocrinology 25: 127–149, 1982

    Article  PubMed  CAS  Google Scholar 

  • Draznin B, Kao M, Sussman KE. Insulin and glyburide increase free calcium concentration in isolated rat adipocytes. Diabetes 36: 174–178 1987

    Article  PubMed  CAS  Google Scholar 

  • Draznin B, Sussman KE, Eckel RH, et al. Possible role of cytosolic free calcium concentrations in mediating insulin resistance of obesity and hypertension. Journal of Clinical Investigation 82: 1848–1852, 1988

    Article  PubMed  CAS  Google Scholar 

  • Ferrannini E, Buzzigoli G, Bonadonna R, et al. Insulin resistance in essential hypertension. New England Journal of Medicine 317: 350–357, 1987

    Article  PubMed  CAS  Google Scholar 

  • Ferrari P, Giachino D, Weidman L, et al. Unalterated insulin sensitivity during calcium channel blockade with amlodipine. European Journal of Clinical Pharmacology 41: 109–113, 1991

    Article  PubMed  CAS  Google Scholar 

  • Ferrari P, Weidmann P. Insulin, insulin sensitivity and hypertension. Journal of Hypertension 8: 491–500, 1990

    Article  PubMed  CAS  Google Scholar 

  • Fink RI, Kolterman OG, Griffin J, et al. Mechanism of insulin resistance in aging. Journal of Clinical Investigation 71: 1523–1529, 1983

    Article  PubMed  CAS  Google Scholar 

  • Giugliano D, Saccomanno F, Paolisso G, et al. Nicardipine does not cause deterioration of glucose homeostasis in man: a placebo controlled study in elderly hypertensive with and without diabetes mellitus. European Journal of Clinical Pharmacology 43: 39–45, 1992

    Article  PubMed  CAS  Google Scholar 

  • Hully SB, Furberg CK, Gurland B, et al. Systolic Hypertension in the Elderly Program (SHEP): antihypertensive efficacy of chlorthalidone. American Journal of Cardiology 56: 913–920, 1985

    Article  Google Scholar 

  • Jackson RA. Mechanisms of age-related glucose intolerance. Diabetes Care 13(Suppl. 2): 9–19, 1990

    Google Scholar 

  • Jauch KW, Guenther B, Hartl W, et al. Improvement of impaired post-operative insulin action by bradykinin. Biological Chemistry Hoppe-Seyler 367: 207–210, 1986

    Article  PubMed  CAS  Google Scholar 

  • Klip A. Is intracellular Ca involved in insulin stimulation of sugar transport? Fact and prejudice. Canadian Journal of Biochemistry 62: 1228–1236, 1984

    Article  CAS  Google Scholar 

  • Kodama J, Katayama S, Tanaka K, et al. Effect of captopril on glucose concentration. Possible role of augmented post- prandial forearm blood flow. Diabetes Care 13: 1109–1111, 1990

    Article  PubMed  CAS  Google Scholar 

  • Laasko M, Edelman V, Brechtel G, et al. Decreased effect of insulin to stimulate skeletal muscle blood flow in obese men. A novel mechanism for insulin resistance. Journal of Clinical Investigation 85: 1844–1852, 1990

    Article  Google Scholar 

  • Levy D, Garrison RJ, Savage D, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. New England Journal of Medicine 322: 1561–1566, 1990

    Article  PubMed  CAS  Google Scholar 

  • Levy D, Garrison RJ, Savage D, et al. Left ventricular mass and incidence of coronary heart disease in an elderly cohort: the Framingham Heart Study. Annals of Internal Medicine 110: 101–107, 1989

    PubMed  CAS  Google Scholar 

  • Lillioja S, Young AA, Culter CL, et al. Skeletal muscle capillary density and fiber type are possible determinations of in vivo insulin resistance in men. Journal of Clinical Investigation 80: 1620–1628, 1987

    Article  Google Scholar 

  • Lithell HOL. Effect of antihypertensive drugs on insulin, glucose and lipid metabolism. Diabetes Care 14: 203–209, 1991

    Article  PubMed  CAS  Google Scholar 

  • Morris AD, Donnely R, Connell JM, et al. Metabolic effects of lacidipine: a placebo-controlled study using the euglycemic hyperinsulinemic glucose clamp. British Journal of Clinical Pharmacology 35: 40–45, 1993

    PubMed  CAS  Google Scholar 

  • Paolisso G, Di Maro G, Cozzolino D, et al. Chronic magnesium administration enhances oxidative glucose metabolism in thiazide treated hypertensive patients. American Journal of Hypertension 5: 681–686, 1992

    PubMed  CAS  Google Scholar 

  • Paolisso G, Gambardella A, Balbi V, et al. Effects of magnesium and nifedipine infusions on insulin action, substrate oxidation and blood pressure in aged hypertensive patients. American Journal of Hypertension 6: 920–926, 1993

    PubMed  CAS  Google Scholar 

  • Paolisso G, Gambardella A, Verza M, et al. ACE-inhibition improves insulin sensitivity in aged insulin-resistant hypertensive patients. Journal of Human Hypertension 6: 175–179, 1992

    PubMed  CAS  Google Scholar 

  • Paolisso G, Marrazzo G, Pizza G, et al. Insulin resistance as a cause of increased blood pressure in the elderly: effects on intracellular ions content. Archives of Gerontology and Geriatrics 11: 23–32, 1990a

    Article  PubMed  CAS  Google Scholar 

  • Paolisso G, Scheen AS, D’Onofrio F, Lefebvre PJ. Magnesium and glucose homeostasis. Diabetologia 313: 511–514, 1990b

    Article  Google Scholar 

  • Paolisso G, Sgambato S, Pizza G, et al. Improved insulin response and action by chronic magnesium administration in aged NIDDM subjects. Diabetes Care 12: 265–269, 1989

    Article  PubMed  CAS  Google Scholar 

  • Pollare T, Lithell H, Berne C. A comparisons of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension. New England Journal of Medicine 321: 868–873, 1989a

    Article  PubMed  CAS  Google Scholar 

  • Pollare T, Lithell H, Mörlin C, et al. Metabolic effects of diltiazem and atenolol: results from a randomized double-blind study with parallel groups. Journal of Hypertension 7: 551–559, 1989b

    Article  PubMed  CAS  Google Scholar 

  • Pollare T, Lithell H, Selinus I, et al. Application of prazosin is associated with an increase of insulin sensitivity in obese patients with hypertension. Diabetologia 31: 415–420, 1988

    Article  PubMed  CAS  Google Scholar 

  • Pollare T, Lithell H, Selinus I, et al. Sensitivity to insulin during treatment with atenolol and metoprolol: a randomised, double-blind study of the effects on carbohydrate and lipo- protein metabolism in patients with hypertension. British Medical Journal 297: 1147–1152, 1989

    Google Scholar 

  • Resnick L. Cellular calcium and magnesium metabolism in the pathophysiology and treatment of hypertension and related metabolic disorders. American Journal of Medicine 93(Suppl. 2A): 11S–20S, 1992

    Article  PubMed  CAS  Google Scholar 

  • Santoro D, Natali A, Palombo C, et al. Effects of chronic angiotensin converting enzyme inhibition on glucose tolerance and insulin sensitivity in essential hypertension. Hypertension 20: 181–191, 1992

    Article  PubMed  CAS  Google Scholar 

  • Varricchio M, Paolisso B, Torella R, D’Ouofrio F. Diabetes and hypertension in the elderly. Journal of hypertension 67(Suppl. 1): 910–915, 1988

    Google Scholar 

  • Veterans Administration Cooperative Study Group on Antihypertensive Agents. Comparison of propranolol and hydrochlorothiazide for initial treatment of hypertension. Journal of the American Medical Association 248: 1996–2003, 1982

    Article  Google Scholar 

  • Vidt DG, Borazanian RA. Calcium channel blockers in geriatric hypertension. Geriatrics 41: 28–38, 1991

    Google Scholar 

  • Williams GH. Converting-enzyme inhibitors in the treatment of hypertension. New England Journal of Medicine 319: 1517–1521, 1988

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Geriatric Medicine and Metabolic Diseases, II University of Naples, Piazza Miraglia 2, I-80138, Napoli, Italy

    Giuseppe Paolisso, Antonio Gambardella, Domenico Galzerano & Michele Varricchio

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  1. Giuseppe Paolisso
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  2. Antonio Gambardella
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  3. Domenico Galzerano
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  4. Michele Varricchio
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Paolisso, G., Gambardella, A., Galzerano, D. et al. Insulin Resistance and Hypertension in the Elderly. Drugs & Aging 4, 403–409 (1994). https://doi.org/10.2165/00002512-199404050-00005

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  • DOI: https://doi.org/10.2165/00002512-199404050-00005

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