EFFECT OF CILAZAPRIL THERAPY ON GLUCOSE AND LIPID-METABOLISM IN PATIENTS WITH HYPERTENSION

The effects of long-term monotherapy with cilazapril, an angiotensin-c onverting enzyme inhibitor, on blood pressure, glucose tolerance, and serum lipid profiles were prospectively investigated in 66 patients wi th hypertension: 23 with normal glucose tolerance and 43 with glucose intolerance (including 9 patients with non-insulin-dependent diabetes mellitus). The levels of plasma glucose, serum insulin, serum lipids, glycated hemoglobin A(1c) (Hb A(1c)), and fructosamine were determined before and during long-term (mean +/- SD, 26.2 +/- 1.2 weeks) therapy with cilazapril. A 75-g oral glucose tolerance test was performed bef ore and during treatment. Significant reductions in both systolic and diastolic blood pressures in both patient groups were maintained durin g the study. Neither fasting nor post-glucose load venous plasma gluco se levels were altered in either group of patients, and no patient wit h normal glucose tolerance developed diabetes mellitus during the stud y. There was no significant change in the insulinogenic index (Delta s erum insulin/Delta venous plasma glucose at 30 minutes post-glucose lo ad) in either group, and glucose intolerance was slightly improved wit h significant reductions (P < 0.01) in Hb A(1c) and fruc tosamine in t he patient group with impaired glucose tolerance. Serum total choleste rol (TC), low-density lipoprotein cholesterol, and triglyceride levels were significantly (P < 0.01) decreased and high-density lipoprotein cholesterol levels increased in patients with hypercholesterolemia (TC levels greater than or equal to 5.69 mmol/L). These results suggest t hat long-term cilazapril therapy may improve glucose and lipid metabol ism in hypertensive patients with impaired glucose tolerance. Cilazapr il also appears to be useful as an antihypertensive agent for hyperten sive patients with either impaired glucose tolerance or hypercholester olemia.