Fernandez R, Puig J G, Rodriguez, Garrido J, Redon J.
Effect of two Antihypertensive combinations on metabolic control in type-2 diabetic hypertensive patients with albuminuria: a randomized, double-blind study.
Med Channel Jan ;10(3):55-61.
The objective of this study was to compare, at equal blood pressure (BP) reduction, the effect of two different combinations on metabolic control and albumninuria in type 2 diabetic hypertensive patients with albuminuria. This was a prospective, randomised, double-blind, parallel, controlled trial carried out in 11 Spanish hospitals. A total of 103 type 2 diabetic patients with stable albuminuria and BP not controlled on monotherapy were randomised of which 93 finished the study. After a 4-week single-blind placebo period, patients were randomised to verapamil SR/trandolapril 180/2mg (VT) or to enalpril/hydrochlorothiazide 20/12.5mg (EH). Treatment duration was 6 months. The main outcome measures were changes in BP 24-h albuminuria, blood glucose and glycated haemoglobin. Overall BP was significantly reduced from 157.3±12.0/98.3±6.4 mm Hg to 140.5±14.5/86.1±8.1 nun Hg (P < 0.001) and albuminuria significantly decreased from 508.6±693.8 mg/24 h to 253.4±517.2 mg/24h (P<0.001), both. without significant differences between treatments. Glycated haemoglobin was not modified on VT: baseline, 5.91±1.43%; end of treatment, 5.94±1.62%, but increased on EH: baseline, 5.96±1.25%; final, 6.41±1.51%, (ANOVA interaction P = 0.040). At the end of the study, a blood glucose < 126 mg/dl was attained in 72.7% of the VT group-improving in 29.5% and worsening in 6.8% of patients improved and 11.4% worsened (P=1.000). There were no changes in body weight, serum creatinine, uric acid, potassium, cholesterol, tryglicerides and serum albumin. In hypertensive type 2 diabetic patients not controlled on monotherapy, both treatments similarly reduced albuminurria. The combination verapamil/ trandolapril seems to allow a better metabolic control than enalapril/hydrochlorothiazide.
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