Hypertension, Vol 17, 15-21, Copyright © 1991 by American Heart Association
R Klauser, R Prager, S Gaube, C Gisinger, C Schnack, E Kuenburg and G Schernthaner
Most antihypertensive drugs have negative effects on metabolic control in
diabetic patients. Calcium antagonists have been widely used in
antihypertensive treatment of diabetics, although a possible influence on
glucose tolerance, insulin secretion, and insulin action is unknown.
Therefore, the effect of the calcium antagonist isradipine on glucose
tolerance and insulin secretion (75 g oral glucose tolerance test) and on
peripheral and hepatic insulin action (euglycemic clamp) was evaluated in
11 type II diabetic patients. All patients were treated with placebo or
isradipine for 8 weeks (double-blind, crossover design). A second group of
six diabetic patients received a thiazide diuretic, hydrochlorothiazide,
according to the same protocol. Systolic blood pressure was significantly
lowered after isradipine and hydrochlorothiazide compared with placebo (127
+/- 3 versus 139 +/- 6 mm Hg and 129 +/- 4 versus 142 +/- 4, respectively;
p less than 0.05). Fasting blood glucose (190 +/- 21 versus 152 +/- 15
mg/dl; p less than 0.01), glucose levels, basal and glucose-stimulated
insulin levels were significantly higher after hydrochlorothiazide compared
with placebo but remained unchanged after calcium antagonist treatment.
Basal hepatic glucose production and peripheral insulin resistance were
significantly elevated after hydrochlorothiazide compared with placebo or
calcium antagonist therapy. These data indicate that the calcium antagonist
isradipine has no effect on glucose tolerance, insulin secretion, and
insulin action in type II diabetic patients and might therefore be a useful
drug for antihypertensive treatment in diabetes mellitus. However, diuretic
treatment can lead to impairment of metabolic control and reduction of
insulin action in type II diabetes mellitus.
ARTICLES
Metabolic effects of isradipine versus hydrochlorothiazide in diabetes mellitus [published erratum appears in Hypertension 1991 May;17(5):722]
Department of Medicine II, University of Vienna, Austria.
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