EFFECT OF CHRONIC INTERMITTENT INTRAVENOUS INSULIN THERAPY ON ANTIHYPERTENSIVE MEDICATION REQUIREMENTS IN IDDM SUBJECTS WITH HYPERTENSION AND NEPHROPATHY

OBJECTIVE - The prevalence of systemic hypertension is increased in pa tients with diabetes. In this prospective, randomized, crossover clini cal trial, we assessed the antihypertensive effects of chronic intermi ttent intravenous insulin therapy (CIIIT) on insulin-dependent diabete s mellitus (IDDM) subjects with hypertension and nephropathy by monito ring the amount of antihypertensive medication (AHM) required to maint ain the blood pressure (BP) less than or equal to 140/90 mmHg. RESEARC H DESIGN AND METHODS - After a stabilization period, 26 hypertensive I DDM subjects were randomly assigned to a control or treatment phase fo r 3 months and then crossed over into the opposite phase for another 3 months. Addition of CIIIT during the treatment phase was the only pro cedural difference between the control and treatment phases. RESULTS - The AHM dosage requirements for maintenance of the baseline BP levels decreased significantly (46%; P < 0.0001) and linearly over time (P < 0.0058) during the treatment phase, while remaining essentially uncha nged during the control phase. CONCLUSIONS - Our data suggest that CII IT markedly improves BP control, as evidenced by the significantly red uced AHM dosage requirements in subjects with IDDM and hypertension, p ossibly through an improvement in vascular reactivity.