title: Does response of RAS blockade on serum K+ levels influence its glycemic-mitigating response when combined with hydrochlorothiazide?
abstract: The authors previously reported that addition of valsartan ameliorated the negative metabolic effects of hydrochlorothiazide in obese hypertensive patients through an enhanced postprandial insulin response. In this secondary analysis, the authors tested whether this enhanced insulin response to valsartan/hydrochlorothiazide was influenced by serum potassium levels, which were reduced to a lesser extent, when compared with amlodipine/hydrochlorothiazide. Results showed that the early insulin response with valsartan plus hydrochlorothiazide occurred regardless of serum potassium levels. Heightened insulin response was, however, not significantly different when patients with normal potassium (>3.9 mEq/L) at baseline and low potassium (≤3.9 mEq/L) at the end of the study were compared with the amlodipine/hydrochlorothiazide group. Despite the influence of serum potassium on insulin secretory response to a glucose challenge, the addition of valsartan maintained normoglycemia in patients given hydrochlorothiazide. Thus, the metabolic response to hydrochlorothiazide was improved with addition of valsartan through an enhanced insulin response that was not greatly affected by changes in potassium levels.
authors: Cardiology Division, University of California at San Francisco School of Medicine, San Francisco, CA, USA. pdeedwania@fresno.ucsf.edu
authors: Prakash C
authors: PC
authors: Deedwania
authors: Dion H
authors: DH
authors: Zappe
authors: Brent M
authors: BM
authors: Egan
authors: Das
authors: D
authors: Purkayastha
authors: Rita
authors: R
authors: Samuel
authors: James R
authors: JR
authors: Sowers
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000494:pharmacology*; D001786:Blood Glucose / Q000187:drug effects; D004232:Diuretics / Q000008:administration & dosage / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage / Q000494:pharmacology*; D006973:Hypertension / Q000188:drug therapy / Q000473:pathology; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal; D010045:Outpatients; D019518:Postprandial Period; D011188:Potassium / Q000097:blood*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D013223:Statistics as Topic; D013777:Tetrazoles / Q000008:administration & dosage / Q000494:pharmacology*; D014633:Valine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D000068756:Valsartan
chemical_list: D000959:Antihypertensive Agents; D001786:Blood Glucose; D004232:Diuretics; D007328:Insulin; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D000068756:Valsartan; D014633:Valine; D011188:Potassium