[Glycemia increases during treatment of hypertension. 13 years' experience in the treatment of middle-aged men, randomized for treatment with beta blockers and diuretics].
BACKGROUND
Hypertension can no longer be evaluated only with regard to the increase of blood pressure; its clinical picture must comprise also metabolic changes with originate from insulin resistance.


RESULTS
The authors submit some incentives from a 13-year long therapeutic follow-up of hypertension in a group of 54 middle-aged men suffering from essential hypertension. From a control group of 38 men they differed as regards blood pressure (174.2 +/- 13.2/112.9 +/- 7.0 mm Hg vs. 126.4 +/- 13.9/77.6 +/- 7.4 mm Hg, p < 0.001), body build (BMI = 28.0 +/- 3.4 kg/m2 vs 23.9 +/- 2.5 kg/m2, p < 0.001), waist/hip ratio 0.98 +/- 0.04 vs 0.94 +/- 0.04, p < 0.05, as well as uric acid serum levels (413.7 +/- 111.0 mumol vs. 362.6 +/- 65.9 mumol/l, p < 0.05) and HDL cholesterol (1.36 +/- 0.30 mmol/l vs. 1.51 +/- 0.48 mmol/l, p < 0.05). However, the fasting blood sugar levels did not differ (5.2 +/- 0.7 mmol/l vs 5.1 +/- 0.6 mmol/l). Although the index of insulin resistance was elevated (6.6 +/- 2.1 vs. 2.84 +/- 1.6, p < 0.01). The blood sugar level rose steadily and reached a level of 18.7% +/- 14.8% (p < 0.01). The increments of the blood sugar level correlated with changes in body weight (1.2% +/- 6.1% r = 0.535, p < 0.001), TAG (4.0% +/- 5.6% r = 0.332, p < 0.05) and the fasting baseline blood sugar levels (r = 0.551, p < 0.001). The mentioned variables contributed to the prediction of increments of the blood sugar level in multiple regression (determined coefficient R2 = 0.51). No relationship with the type of treatment was revealed. 11% of the patients developed during the investigation period symptoms of type 2 diabetes. The development of diabetes could be predicted on the basis of three baseline variables- the BMI, the index of insulin resistance and the basal blood sugar level (logistic regression, r = 0.790.


CONCLUSIONS
Hypertension is a constituent of the metabolic syndrome, although the rise of the blood sugar does not directly correlate with manifestation of type 2 diabetes, it is a warning that insulin resistance can influence the effectiveness of provisions of the therapeutic regimen, and last not least, also the development of type 2 diabetes.
Válek
J
J
Klinika diabetologie a hepatogastroenterologie IKEM, Praha, IPVZ, Praha.
Válková
L
L
Storková
H
H
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000187:drug effects; D004232:Diuretics; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D006973:Hypertension / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D008875:Middle Aged; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D001786:Blood Glucose; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors; D006852:Hydrochlorothiazide; D008790:Metoprolol
Glykémie se zvysuje pri lécbĕ hypertenze. Zkusenosti z 13 let trvající lécby skupiny muzů stredního vĕku, randomizované k lécbĕ betablokátory, resp. diuretiky.