Angiotensin receptor blocker/diuretic combination preserves insulin responses in obese hypertensives

James R. Sowers, Leopoldo Raij, Ishwaral Jialal, Brent M. Egan, Elizabeth O. Ofili, Rita Samuel, Dion H. Zappe, Das Purkayastha, Prakash C. Deedwania

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: Thiazide diuretics can impair glucose metabolism and increase new-onset diabetes. Adding an angiotensin receptor blocker to diuretics may protect against these metabolic effects; however, the mechanism of this protection is unclear. Method: To explore potential mechanisms, a 16-week multicenter trial was conducted to ascertain the relative glucose metabolism effects of combined hydrochlorothiazide and angiotensin receptor blocker (valsartan) therapy compared with hydrochlorothiazide and calcium channel blocker (amlodipine) treatment in 412 centrally obese hypertensive individuals (BMI = 35 ± 7 kg/m2, seated BP = 159 ± 8/94 ± 8 mmHg, and mean age 56 years). Individuals were randomized to valsartan/hydrochlorothiazide, with force-titration to 320/25 mg or hydrochlorothiazide, with titration to hydrochlorothiazide 25 mg and amlodipine 10 mg, respectively. Changes from baseline to week 16 in fasting and 2-h postprandial glucose and insulin levels after an oral glucose load were measured. Results: At week 16, clinic blood pressure reductions were similar (P > 0.05) in both groups. Fasting and 2-h glucose levels increased (P < 0.05) with the amlodipine combination but not with the valsartan combination. In concert with these glucose responses, postprandial insulin increases from baseline were substantially greater with valsartan than with amlodipine plus hydrochlorothiazide group (P = 0.001). The glucose responses were inversely related to insulin responses at the study conclusion. Conclusion: The novel observation of this investigation was that the combination of valsartan and hydrochlorothiazide was associated with greater glucose-stimulated insulin secretory and lesser glycemic excursion responses than the amlodipine combination group. Thus, this data suggests that adding an angiotensin receptor blocker attenuates the negative effects of thiazides on pancreatic beta-cell glucose-induced insulin secretion.

Original languageEnglish
Pages (from-to)1761-1769
Number of pages9
JournalJournal of Hypertension
Volume28
Issue number8
DOIs
StatePublished - Aug 1 2010

Fingerprint

Angiotensin Receptor Antagonists
Diuretics
Valsartan
Hydrochlorothiazide
Insulin
Glucose
Amlodipine
Fasting
Thiazides
Sodium Chloride Symporter Inhibitors
Insulin-Secreting Cells
Calcium Channel Blockers
Multicenter Studies
Observation
Blood Pressure

Keywords

  • hydrochlorothiazide
  • hypertension
  • insulin secretion
  • metabolic syndrome
  • obesity
  • valsartan

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Sowers, J. R., Raij, L., Jialal, I., Egan, B. M., Ofili, E. O., Samuel, R., ... Deedwania, P. C. (2010). Angiotensin receptor blocker/diuretic combination preserves insulin responses in obese hypertensives. Journal of Hypertension, 28(8), 1761-1769. https://doi.org/10.1097/HJH.0b013e32833af380

Angiotensin receptor blocker/diuretic combination preserves insulin responses in obese hypertensives. / Sowers, James R.; Raij, Leopoldo; Jialal, Ishwaral; Egan, Brent M.; Ofili, Elizabeth O.; Samuel, Rita; Zappe, Dion H.; Purkayastha, Das; Deedwania, Prakash C.

In: Journal of Hypertension, Vol. 28, No. 8, 01.08.2010, p. 1761-1769.

Research output: Contribution to journalArticle

Sowers, JR, Raij, L, Jialal, I, Egan, BM, Ofili, EO, Samuel, R, Zappe, DH, Purkayastha, D & Deedwania, PC 2010, 'Angiotensin receptor blocker/diuretic combination preserves insulin responses in obese hypertensives', Journal of Hypertension, vol. 28, no. 8, pp. 1761-1769. https://doi.org/10.1097/HJH.0b013e32833af380
Sowers, James R. ; Raij, Leopoldo ; Jialal, Ishwaral ; Egan, Brent M. ; Ofili, Elizabeth O. ; Samuel, Rita ; Zappe, Dion H. ; Purkayastha, Das ; Deedwania, Prakash C. / Angiotensin receptor blocker/diuretic combination preserves insulin responses in obese hypertensives. In: Journal of Hypertension. 2010 ; Vol. 28, No. 8. pp. 1761-1769.
@article{d39c50d42f3441ce88ed44efe29061f9,
title = "Angiotensin receptor blocker/diuretic combination preserves insulin responses in obese hypertensives",
abstract = "Lippincott Williams & Wilkins.",
keywords = "hydrochlorothiazide, hypertension, insulin secretion, metabolic syndrome, obesity, valsartan",
author = "Sowers, {James R.} and Leopoldo Raij and Ishwaral Jialal and Egan, {Brent M.} and Ofili, {Elizabeth O.} and Rita Samuel and Zappe, {Dion H.} and Das Purkayastha and Deedwania, {Prakash C.}",
year = "2010",
month = "8",
day = "1",
doi = "10.1097/HJH.0b013e32833af380",
language = "English",
volume = "28",
pages = "1761--1769",
journal = "Journal of Hypertension",
issn = "0263-6352",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Angiotensin receptor blocker/diuretic combination preserves insulin responses in obese hypertensives

AU - Sowers, James R.

AU - Raij, Leopoldo

AU - Jialal, Ishwaral

AU - Egan, Brent M.

AU - Ofili, Elizabeth O.

AU - Samuel, Rita

AU - Zappe, Dion H.

AU - Purkayastha, Das

AU - Deedwania, Prakash C.

PY - 2010/8/1

Y1 - 2010/8/1

N2 - Lippincott Williams & Wilkins.

AB - Lippincott Williams & Wilkins.

KW - hydrochlorothiazide

KW - hypertension

KW - insulin secretion

KW - metabolic syndrome

KW - obesity

KW - valsartan

UR - http://www.scopus.com/inward/record.url?scp=77954957395&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954957395&partnerID=8YFLogxK

U2 - 10.1097/HJH.0b013e32833af380

DO - 10.1097/HJH.0b013e32833af380

M3 - Article

VL - 28

SP - 1761

EP - 1769

JO - Journal of Hypertension

JF - Journal of Hypertension

SN - 0263-6352

IS - 8

ER -