title: Losartan attenuates symptomatic and hormonal responses to hypoglycemia in humans.
abstract: OBJECTIVE
  Reduced awareness of hypoglycemic symptoms and compromised hormonal counterregulation increase the risk of severe hypoglycemia in people with diabetes mellitus. Up to the present, angiotensin 1 receptor blockers, which play an important role in controlling diabetic complications, have not been known to increase the risk of hypoglycemia. Nevertheless, we observed 3 cases of diabetic patients complaining of reduced awareness of hypoglycemic symptoms while they were under treatment with losartan in our outpatients clinic. We therefore investigated the effects of losartan on symptomatic and hormonal responses to hypoglycemia in humans.
  
  
  METHODS
  We carried out a randomized, double-blind, crossover study including 16 healthy men. The subjects received losartan 50 mg/d versus placebo. Treatment periods lasted for 7 days and were followed by a stepwise hypoglycemic clamp session (4.5 to 3.8 to 3.1 to 2.4 mmol/L) with measurement of counterregulatory hormones (epinephrine, norepinephrine, adrenocorticotropin, cortisol, glucagon), symptoms, and hemodynamic parameters (blood pressure, heart rate).
  
  
  RESULTS
  Losartan attenuated the hypoglycemia-induced rise in plasma epinephrine (6480 +/- 490 pmol/L versus placebo 8970 +/- 790 pmol/L; P <.001) and the rise in plasma adrenocorticotropin (21 +/- 2 pmol/L versus 26 +/- 3 pmol/L; P <.01). Losartan also reduced symptom scores during hypoglycemia (P <.05).
  
  
  CONCLUSIONS
  We conclude that short-term treatment with losartan slightly attenuates symptomatic and hormonal responses to hypoglycemia. At present, for patients who are unaware of hypoglycemia and who require antihypertensive or nephroprotective treatment, we would recommend caution concerning treatment with losartan.
authors.affiliation: Medical Clinic I, Department of Clinical Neuroendocrinology, Institute for Pharmacology, Medical University Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Deininger
authors.forename: K M
authors.initials: KM
authors.lastname: Oltmanns
authors.forename: P
authors.initials: P
authors.lastname: Wellhoener
authors.forename: B
authors.initials: B
authors.lastname: Fruehwald-Schultes
authors.forename: W
authors.initials: W
authors.lastname: Kern
authors.forename: B
authors.initials: B
authors.lastname: Heuer
authors.forename: P
authors.initials: P
authors.lastname: Dominiak
authors.forename: J
authors.initials: J
authors.lastname: Born
authors.forename: H L
authors.initials: HL
authors.lastname: Fehm
authors.forename: A
authors.initials: A
authors.lastname: Peters
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents / Q000494:pharmacology*; D000075202:Contraindications; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004837:Epinephrine / Q000097:blood; D005934:Glucagon / Q000097:blood; D015309:Glucose Clamp Technique; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D019808:Losartan / Q000494:pharmacology*; D008297:Male; D009638:Norepinephrine / Q000097:blood; D044140:Receptor, Angiotensin, Type 1; D012084:Renin-Angiotensin System / Q000187:drug effects
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents; D044140:Receptor, Angiotensin, Type 1; D000324:Adrenocorticotropic Hormone; D005934:Glucagon; D019808:Losartan; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine