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Erschienen in:
01.10.2002 | Original Research Article
Effects on Blood Pressure of the α-Glucosidase Inhibitor Acarbose Compared with the Insulin Enhancer Glibenclamide in Patients with Hypertension and Type 2 Diabetes Mellitus
Erschienen in: Clinical Drug Investigation | Ausgabe 10/2002
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Aim
To investigate the relationship between hypertension and hyperinsulinaemia, the effects on blood pressure and insulin levels of two oral antidiabetic agents with different mechanisms of action, acarbose (an α-glucosidase inhibitor) and glibenclamide (an insulin promoter), were compared in patients with hypertension and type 2 diabetes mellitus.
Patients
Obese men and women (mean age 57.5 years) with mild hypertension (WHO grade I or II) and type 2 diabetes mellitus. Study design: Patients (n = 76) were randomised to receive either acarbose 300 mg/day or glibenclamide 5 mg/day for up to 6 months. Twenty-four-hour blood pressure (BP) profiles were recorded at baseline, and after 3 months and 6 months of treatment. Lifestyle modification was allowed, but no concomitant antihypertensive drugs were permitted.
Results
At baseline, mean 24-hour systolic/diastolic BP was 134.9 ± 11.6/84.2 ± 6.2mm Hg in the acarbose-treated group versus 138.5 ± 14.1/85.9 + 6.2mm Hg in glibenclamide-treated patients. At 6 months, mean 24-hour systolic BP was reduced by a mean 5.2mm Hg with acarbose versus only 1.6mm Hg with glibenclamide (p = 0.0001). Mean 24-hour diastolic BP fell by 2.4mm Hg and 5.5mm Hg with acarbose and glibenclamide treatment, respectively (p = 0.003). Fasting serum insulin levels were significantly (p < 0.05) lower following 6 months’ treatment with acarbose versus glibenclamide (7.9 ± 2.3 mU/L vs 22.3 ± 19.1 mU/L, respectively), as were post-prandial insulin levels (51.6 ± 43.1 mU/L vs 59.0 ± 51.4 mU/L, respectively). Acarbose therapy was also associated with improvement (reduction) in bodyweight and glycosylated haemoglobin (HbA1c) values.
Conclusion
Oral antidiabetic agents with different mechanisms of action appear to have significant effects on BP in patients with hypertension and diabetes mellitus, albeit in different ways. Acarbose may be useful in lowering BP in certain patients with type 2 diabetes mellitus, particularly those with isolated systolic hypertension.