EFFECTS OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS ON GLUCOSE AND LIPID-METABOLISM IN ESSENTIAL-HYPERTENSION

Data of 52 patients, 29 women and 23 men aged 32-68 years (mean age 47 years) with essential hypertension, participating in three open thera peutic trials with either enalapril, lisinopril, or perindopril were e valuated to assess the effects of angiotensin-converting enzyme (ACE) inhibition on glucose and lipid metabolism. The 75-g oral glucose tole rance test (0GTT) was performed, and plasma glucose and insulin levels , as well as total cholesterol, high-density lipoprotein (HDL)choleste rol, and triglycerides levels were determined before and after the 8- to 12-week treatment. Minor differences in the blood pressure (BP)-low ering effect and metabolic response were obtained with the ACE inhibit ors studied; only lisinopril improved glucose tolerance significantly; blood lipids were not changed by any drug. The entire patient populat ion showed only a slight reduction in l-h postload glucose after treat ment. More obvious improvement in glucose tolerance was evident in hyp ertensive patients who were glucose intolerant and/or insulin resistan t (GI/IR, 53.8% of all), however. This subgroup also showed a slight b ut not significant increase in HDL-cholesterol and a decrease in trigl ycerides levels. Only a slight change or no change in plasma glucose, insulin, and lipid values was noted in hypertensive patients with norm al glucose tolerance (NGT) and insulin sensitivity. These favorable ef fects were expressed only after ACE inhibitor monotherapy, but not whe n hydrochlorothiazide was added. The results indicate that a lack of s tratification of hypertensive patients with regard to glucose toleranc e or insulin sensitivity could be a confounding factor in evaluation o f metabolic effects of ACE inhibitors.