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Abstract

Endothelial dysfunction has been suggested to provide a link between hypertension and insulin resistance. ACE inhibition has shown to improve endothelial function and insulin resistance in diabetic patients. But it has not been determined in hypertensive patients.

The aim of this study was to evaluate the effects of ACE inhibition on insulin sensitivity and endothelial function in essential hypertensive patients.

Ten non smokers with untreated essential hypertension (34.8±8 yrs,M/F3/5) and 8 age and sex matched healthy subjects (34±7,M/F2/6) were included in the study. Hypertensive patients were given Enalapril maleate (10-40 mg/day ) and followed for 3 months. During treatment 2 patients dropped out because of cough. Following parameters were measured at the beginning and at the end of the study. Whole body insulin sensitivity was measured by a formula described by Matsuda and Defronzo which is derived from oral glucose tolerance test (OGTT) [ISI (composite)=10.000/square root of fasting plasma glucose x fasting plasma insulin x (mean glucose OGTT x mean insulin OGTT)]. Endothelial function was evaluated as flow mediated dilatation (FMD) on brachial artery by ultrasonograpy and expressed as a percentage of change relative to baseline diameter. Ambulatory blood pressure measurements were done. Results are expressed as mean ±SEM

In conclusion essential hypertensive patients have impaired endothelial function and decreased whole body insulin sensitivity compared with healthy subjects. This data indicate that ACE inhibition have beneficial effects on insulin sensitivity and endothelial dysfunction in essential hypertensive patients. (See Table)

hypertensives
before treatmentafter treatmentControl Group
SBP (mmHg)152.7 ± 3.7*125.2 ± 3°117.5 ± 5.5
DBP (mmHg)98.7 ± 2.7*80.6 ± 3.7°74.1 ± 2.5
FMD (%)8.9 ± 1.7**25.1 ± 3.9°°30.1 ± 2.1
ISI(composite)4.2 ± 0.7***9.2 ± 1.1°°11.8 ± 2.1
hypertensives
before treatmentafter treatmentControl Group
SBP (mmHg)152.7 ± 3.7*125.2 ± 3°117.5 ± 5.5
DBP (mmHg)98.7 ± 2.7*80.6 ± 3.7°74.1 ± 2.5
FMD (%)8.9 ± 1.7**25.1 ± 3.9°°30.1 ± 2.1
ISI(composite)4.2 ± 0.7***9.2 ± 1.1°°11.8 ± 2.1

FMD was found to be correlated with ISI (r= 0.54,p=0.03), DBP (r= -0.85,p<0.0001) and SBP(r= -0.63,p<0.005)

ISIwere significantly correlated with SBP (r= -.79,p<0.0005) and DBP (r=-0.56, p=0.02) in whole study group

*

p<0.05

**

p<0.001 vs

***

p<0.01 vs kontrol group

°

p<0.01

°°

p<0.0001 vs before treatment, °° p<0.05 vs before treatment

hypertensives
before treatmentafter treatmentControl Group
SBP (mmHg)152.7 ± 3.7*125.2 ± 3°117.5 ± 5.5
DBP (mmHg)98.7 ± 2.7*80.6 ± 3.7°74.1 ± 2.5
FMD (%)8.9 ± 1.7**25.1 ± 3.9°°30.1 ± 2.1
ISI(composite)4.2 ± 0.7***9.2 ± 1.1°°11.8 ± 2.1
hypertensives
before treatmentafter treatmentControl Group
SBP (mmHg)152.7 ± 3.7*125.2 ± 3°117.5 ± 5.5
DBP (mmHg)98.7 ± 2.7*80.6 ± 3.7°74.1 ± 2.5
FMD (%)8.9 ± 1.7**25.1 ± 3.9°°30.1 ± 2.1
ISI(composite)4.2 ± 0.7***9.2 ± 1.1°°11.8 ± 2.1

FMD was found to be correlated with ISI (r= 0.54,p=0.03), DBP (r= -0.85,p<0.0001) and SBP(r= -0.63,p<0.005)

ISIwere significantly correlated with SBP (r= -.79,p<0.0005) and DBP (r=-0.56, p=0.02) in whole study group

*

p<0.05

**

p<0.001 vs

***

p<0.01 vs kontrol group

°

p<0.01

°°

p<0.0001 vs before treatment, °° p<0.05 vs before treatment

endothelial dysfunction, insulin resistance, hypertension
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© American Journal of Hypertension, Ltd. 2001
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