Swiss Hypertension Treatment Programme with Verapamil And/or Enalapril in Diabetic Patients

Overview

Journal Drugs

Specialty Pharmacology

Date 1992 Jan 1

PMID 1283588

Authors

C Ferrier

P Ferrari

P Weidmann

U Keller

W F Riesen

Affiliations

Soon will be listed here.

Abstract

The purpose of the present study was to assess the efficacy and tolerability of diuretic-free antihypertensive therapy with a calcium antagonist and/or an angiotensin converting enzyme (ACE) inhibitor in patients with diabetes mellitus. 54 hypertensive [blood pressure (BP) above 140/90mm Hg] patients with diabetes mellitus type 1 (n = 7) or 2 (n = 47) and normal serum creatinine levels (mean 82 +/- 6 mumol/L) received either verapamil or enalapril after a 2-week washout and a 4-week placebo phase. If BP remained elevated, both agents were combined. Verapamil or enalapril alone normalised diastolic BP (to less than 90mm Hg) in 36 patients; verapamil decreased BP from 159/98 to 147/87mm Hg (n = 19, p < 0.001) and enalapril decreased BP from 166/99 to 146/88mm Hg (n = 17, p < 0.001). In 18 patients who remained hypertensive after 10 weeks of monotherapy, a combination of both drugs decreased BP from 169/104 to 151/90mm Hg (p < 0.001). Overall, 87% of patients achieved a target BP response at 30 weeks. Urinary albumin as related to creatinine excretion (UAE; micrograms albumin:mg creatinine) was on average not significantly changed after verapamil or enalapril treatment, alone or combined. Nevertheless, in patients with initial microalbuminuria, UAE decreased (p < 0.05) during enalapril treatment. Serum potassium, total lipids, high density lipoprotein cholesterol, low density lipoprotein cholesterol, glycosylated haemoglobin, serum C peptide and fructosamine levels were not significantly modified by treatment. Subjective tolerability of the drugs was also generally good. Thus, in hypertensive patients with diabetes, a diuretic-free therapy based on the calcium antagonist verapamil or the ACE inhibitor enalapril, alone or combined, can effectively decrease BP without adversely affecting carbohydrate and lipid metabolism.

References

Assmann G, Schulte H . The Prospective Cardiovascular Münster (PROCAM) study: prevalence of hyperlipidemia in persons with hypertension and/or diabetes mellitus and the relationship to coronary heart disease. Am Heart J. 1988; 116(6 Pt 2):1713-24. DOI: 10.1016/0002-8703(88)90220-7. View

Mogensen C . Long-term antihypertensive treatment inhibiting progression of diabetic nephropathy. Br Med J (Clin Res Ed). 1982; 285(6343):685-8. PMC: 1499854. DOI: 10.1136/bmj.285.6343.685. View

Hawthorne V . Preventing the kidney disease of diabetes mellitus: public health perspectives. Am J Kidney Dis. 1989; 13(1):1-6. DOI: 10.1016/s0272-6386(89)80103-9. View

Feldt-Rasmussen B, Mathiesen E, Deckert T, Giese J, Christensen N, Nielsen M . Central role for sodium in the pathogenesis of blood pressure changes independent of angiotensin, aldosterone and catecholamines in type 1 (insulin-dependent) diabetes mellitus. Diabetologia. 1987; 30(8):610-7. DOI: 10.1007/BF00277316. View

Mimran A, Insua A, Ribstein J, Monnier L, Bringer J, MIROUZE J . Contrasting effects of captopril and nifedipine in normotensive patients with incipient diabetic nephropathy. J Hypertens. 1988; 6(11):919-23. DOI: 10.1097/00004872-198811000-00011. View

Peer G, Korzets A, Levtov O . Plasma lipid profile in verapamil-treated hypertensive patients. Int J Clin Pharmacol Ther Toxicol. 1987; 25(9):489-92. View

Pyorala K, Savolainen E, Kaukola S, Haapakoski J . Plasma insulin as coronary heart disease risk factor: relationship to other risk factors and predictive value during 9 1/2-year follow-up of the Helsinki Policemen Study population. Acta Med Scand Suppl. 1985; 701:38-52. DOI: 10.1111/j.0954-6820.1985.tb08888.x. View

LARAGH J, Case D, Atlas S, SEALEY J . Captopril compared with other antirenin system agents in hypertensive patients: its triphasic effects on blood pressure and its use to identify and treat the renin factor. Hypertension. 1980; 2(4):586-93. DOI: 10.1161/01.hyp.2.4.586. View

Wada S, Nakayama M, Masaki K . Effects of diltiazem hydrochloride on serum lipids: comparison with beta-blockers. Clin Ther. 1982; 5(2):163-73. View

10.

Trost B, Weidmann P . Antihypertensive therapy in diabetic patients. Hypertension. 1985; 7(6 Pt 2):II102-8. DOI: 10.1161/01.hyp.7.6_pt_2.ii102. View

11.

Warram J, Laffel L, Valsania P, Christlieb A, Krolewski A . Excess mortality associated with diuretic therapy in diabetes mellitus. Arch Intern Med. 1991; 151(7):1350-6. View

12.

Mogensen C . Microalbuminuria as a predictor of clinical diabetic nephropathy. Kidney Int. 1987; 31(2):673-89. DOI: 10.1038/ki.1987.50. View

13.

Midtbo K, Lauve O, Hals O . No metabolic side effects of long-term treatment with verapamil in hypertension. Angiology. 1988; 39(12):1025-9. DOI: 10.1177/000331978803901204. View

14.

Murphy M, Lewis P, Kohner E, SCHUMER B, Dollery C . Glucose intolerance in hypertensive patients treated with diuretics; a fourteen-year follow-up. Lancet. 1982; 2(8311):1293-5. DOI: 10.1016/s0140-6736(82)91506-9. View

15.

Burstein M, Scholnick H, Morfin R . Rapid method for the isolation of lipoproteins from human serum by precipitation with polyanions. J Lipid Res. 1970; 11(6):583-95. View

16.

. Blood glucose control and the evolution of diabetic retinopathy and albuminuria. A preliminary multicenter trial. N Engl J Med. 1984; 311(6):365-72. DOI: 10.1056/NEJM198408093110604. View

17.

Riesen W, Sturzenegger E, Imhof C, Mordasini R . Quantitation of apolipoprotein B by polyclonal and monoclonal antibodies. Clin Chim Acta. 1986; 154(1):29-40. DOI: 10.1016/0009-8981(86)90085-9. View

18.

Kaplan N . Our appropriate concern about hypokalemia. Am J Med. 1984; 77(1):1-4. DOI: 10.1016/0002-9343(84)90427-3. View

19.

Gambaro G, Morbiato F, Cicerello E, Del Turco M, Sartori L, DAngelo A . Captopril in the treatment of hypertension in type I and type II diabetic patients. J Hypertens Suppl. 1985; 3(2):S149-51. View

20.

Weidmann P, Keusch G . Responsiveness of plasma renin and aldosterone in diabetes mellitus. Kidney Int. 1981; 20(2):259-66. DOI: 10.1038/ki.1981.129. View