Effects of nitrendipine and hydrochlorothiazide on postprandial blood pressure reduction and carbohydrate metabolism in hypertensive patients over 70 years of age.
Recently, it has been recognized that blood pressure (BP) in the elderly may decrease after a meal or oral glucose loading. Calcium antagonists and diuretics have been advocated as first-line drugs for the treatment of hypertension in the elderly. It is not known whether these antihypertensive drugs may further deteriorate or improve BP homeostasis after a meal. Therefore, we studied in a double-blind parallel study the effects of a 12-week treatment with nitrendipine, 20 mg once daily, and hydrochlorothiazide, 50 mg once daily, on BP homeostasis after an oral glucose loading. In addition, the effects of both agents on carbohydrate metabolism were studied. Before treatment, mean BP decreased by 13 +/- 1 mm Hg (SEM) (10%, p less than 0.001) 60 min after the glucose loading in the nitrendipine group [n = 9, age 73 +/- 3 (SD) years] and by 9 +/- 2 (SEM) mm Hg (7%, p less than 0.01) in the hydrochlorothiazide group [n = 13, age 76 +/- 4 (SD) years]. After 12 weeks of treatment, oral glucose loading resulted in mean BP reductions of 7 +/- 2 mm Hg (6%, p less than 0.01) and 4 +/- 2 mm Hg (4%, not significant) in the nitrendipine and hydrochlorothiazide groups, respectively. In the hydrochlorothiazide group, the area under the curve of plasma glucose was significantly higher after treatment than before (p = 0.03). We conclude that antihypertensive treatment with nitrendipine or hydrochlorothiazide improves BP homeostasis after an oral glucose loading. In contrast to nitrendipine, 12 weeks of treatment with hydrochlorothiazide slightly impairs carbohydrate metabolism.
Jansen
R W
RW
Department of Medicine, University Hospital Nijmegen, The Netherlands.
van Lier
H J
HJ
Hoefnagels
W H
WH
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000187:drug effects; D002986:Clinical Trials as Topic; D004311:Double-Blind Method; D005260:Female; D005947:Glucose; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D009568:Nitrendipine / Q000627:therapeutic use*; D009638:Norepinephrine / Q000097:blood; D011897:Random Allocation
D001786:Blood Glucose; D006852:Hydrochlorothiazide; D009568:Nitrendipine; D005947:Glucose; D009638:Norepinephrine