title: Effects of antihypertensive therapy on glucose, insulin metabolism, left ventricular diastolic dysfunction and renin system in overweight and obese hypertensives.
abstract: BACKGROUND
  We attempted to test the hypothesis that the direct renin inhibitor aliskiren can improve diastolic dysfunction, glucose, and insulin metabolism (GIM) in overweight and obese hypertensive patients.
  
  
  RESULTS
  Seventy-eight hypertensive patients were divided into two groups: 38 treated with aliskiren for six months, and 40 treated without aliskiren but with only traditional anti-hypertensive therapy, as controls. Doppler mitral flow velocity patterns were assessed before and after aliskiren during a six-month period. GIM (three-hour intravenous glucose tolerance test) was measured after four to six weeks of washout and six months of treatment. The mitral E/A ratio increased from 0.65 ± 0.11 to 0.75 ± 0.19. None of the indexes changed in the control group. In the control group, GIM parameters, fasting glucose levels (5.3 ± 0.9 to 6.0 ± 1.5 mmol/l; p = 0.003), fasting insulin levels (121 ± 121 to 189 ± 228 pmol/l; p = 0.03), and most other relevant metabolic measures (p < 0.05 for all) significantly worsened. Aliskiren did not affect GIM. In the control group LVM/height was not affected (119 ± 12 to 120 ± 17 g/m; p = 0.8), whereas aliskiren significantly reduced LVM/height (120 ± 13 to 111 ± 19 g/m; p = 0.04).
  
  
  CONCLUSIONS
  Optimal target BP was achieved in the group as a whole and in both obese patient groups, while benefits to cardiac structure were of a smaller magnitude. In high-risk, overweight/obese patients with hypertension, traditional therapy provides significantly greater BP- versus aliskiren-lowering throughout the 24-hour dosing interval. Therefore in obese, hypertensive individuals, adequate and similar blood pressure control was achieved with aliskiren; however, the aliskiren group and not the control group was associated with a more favorable GIM profile and led to a significant regression of LVM; overall aliskiren-based treatment offers sustained control of PRA.
authors: Cardiology Unit, University "Federico II" Italy mlderosa@unina.it.
authors: Maria Leonarda
authors: ML
authors: De Rosa
authors: Cardiology Unit, University "Federico II" Italy.
authors: Francesca
authors: F
authors: Musella
authors: Cardiology Unit, University "Federico II" Italy.
authors: Federica
authors: F
authors: Ilardi
authors: Cardiology Unit, University "Federico II" Italy.
authors: Carmen
authors: C
authors: D'Amore
authors: Cardiology Unit, University "Federico II" Italy.
authors: Rossella
authors: R
authors: Luciano
authors: Cardiology Unit, University "Federico II" Italy.
authors: Fabio
authors: F
authors: Maresca
mesh_terms: D000368:Aged; D000577:Amides / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers; D001786:Blood Glucose / Q000378:metabolism*; D005260:Female; D005650:Fumarates / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D007328:Insulin / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D012083:Renin / Q000097:blood; D012084:Renin-Angiotensin System / Q000187:drug effects*; D014463:Ultrasonography; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D015415:Biomarkers; D001786:Blood Glucose; D005650:Fumarates; D007328:Insulin; C446481:aliskiren; D012083:Renin