THE RISK OF DEVELOPING DIABETES IN HYPERTENSION : -Insulin sensitivity, AT-1 receptor blockade and sympathetic activity

Abstract

Patients with hypertension have a high risk of developing diabetes mellitus. We investigated predictors of diabetes development among 15245 high risk hypertensive patients included the VALUE trial and blood glucose and BMI were the most important predictors. The patients who developed diabetes mellitus during the average 4.2 year of the trial had increased cardiac morbidity (myocardial infarction and heart failure) compared with patients that did not develop diabetes mellitus.<br> Antihypertensive treatment with additional Angiotensin II AT1-receptor blockade improved insulin sensitivity measured with the hyperinsulinaemic isoglycaemic glucose clamp compared to treatment with calcium channel blocker alone in a double-bind, randomised crossover study of 21 patients with hypertension and other cardiovascular risk factors. No significant differences were found in adipokines, inflammatory variables and whole blood viscosity, but a significant reduction in plasma noradrenaline was found. One possible mechanism for the improved insulin sensitivity by AT1-receptor blockade may be effects on the sympathetic nervous system.