title: Effects of losartan and amlodipine alone or combined with simvastatin in hypertensive patients with nonalcoholic hepatic steatosis.
abstract: OBJECTIVE
  The inhibition of the renin-angiotensin system and of the 3-hydroxy-3-methylglutaryl-coenzyme A reductase could improve hepatic steatosis. The aim of this study was to evaluate the effects of losartan or amlodipine alone or combined with simvastatin on hepatic steatosis degree, and on insulin sensitivity in normocholesterolemic, hypertensive patients with nonalcoholic hepatic steatosis.
  
  
  METHODS
  Patients were treated with losartan, 100 mg/day, or amlodipine, 10 mg/day, for 6 months; subsequently simvastatin, 20 mg/day was added to both treatments for a further 6 months. The patients performed an ultrasound examination [steatosis degree, subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) diameter], an euglycemic hyperinsulinemic clamp [glucose infusion rate (GIR)], and a blood sample (fasting plasma glucose, fasting plasma insulin, triglycerides, and inflammatory parameters) at baseline, and after 6 and 12 months, respectively.
  
  
  RESULTS
  Both losartan and amlodipine induced a significant and similar systolic blood pressure/diastolic blood pressure reduction (P<0.001 vs. baseline). Losartan significantly increased GIR (P<0.05 vs. baseline) compared with amlodipine therapy, and the addition of simvastatin to losartan further increased GIR compared with the simvastatin added to amlodipine therapy (P<0.01 and P<0.05 vs. baseline, respectively). Losartan significantly decreased the steatosis degree, SAT, and VAT diameter compared with amlodipine therapy (P<0.05 vs. baseline with losartan for all). The addition of simvastatin to losartan therapy further decreased the steatosis degree, SAT, and VAT diameter.
  
  
  CONCLUSIONS
  Losartan and simvastatin combination significantly improved the hepatic steatosis indices compared with amlodipine and simvastatin combination.
authors.affiliation: Department of Internal Medicine and Therapeutics, Centro Ipertensione e Fisiopatologia Cardiovascolare, University of Pavia, Pavia, Italy. r.fogari@unipv.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Fogari
authors.forename: Pamela
authors.initials: P
authors.lastname: Maffioli
authors.forename: Amedeo
authors.initials: A
authors.lastname: Mugellini
authors.forename: Annalisa
authors.initials: A
authors.lastname: Zoppi
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Lazzari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Derosa
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D001835:Body Weight; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005234:Fatty Liver / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D015309:Glucose Clamp Technique; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D018836:Inflammation Mediators / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology; D008055:Lipids / Q000097:blood; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019821:Simvastatin / Q000627:therapeutic use*; D014463:Ultrasonography
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D018836:Inflammation Mediators; D008055:Lipids; D017311:Amlodipine; D019821:Simvastatin; D019808:Losartan