Metabolic effects of temocapril in hypertensive patients with diabetes mellitus type 2

Compared with other angiotensin-converting enzyme (ACE) inhibitors, the eli mination of temocapril is less dependent on renal function. To investigate the metabolic and antihypertensive effects of temocapril in diabetic hypert ensives, 30 patients with diabetes mellitus type 2 and mild to moderate hyp ertension [diastolic blood pressure (BP) 90-115 mm Hg] and without azotemia (plasma creatinine <180 mu M) were evaluated in a prospective randomized d ouble-blind placebo-controlled study. After a 4-week placebo run-in, they r eceived temocapril, 20 mg daily (n = 19), or placebo (n = 11) for 6 weeks. Insulin sensitivity index (SI), determined by the Minimal Model method of B ergman, serum lipoproteins, plasma renin activity, fibrinogen, and microalb uminuria were assessed at the end of the placebo run-in phase and the doubl e-blind treatment phases. Temocapril but not placebo administration produce d a significant decrease in supine BP (152/92 +/- 5/3 vs. 162/98 +/- 5/2 mm Hg; p < 0.01) and increase in plasma renin (p < 0.05). Variation of SI dur ing temocapril treatment did not reach statistical significance (0.95 +/- 0 .2 before vs. 1.44 +/- 0.4 x 10(-4)/min/mU/L after treatment). During admin istration of temocapril or placebo, no significant changes in fasting plasm a glucose, insulin, and serum levels of total triglycerides, cholesterol, l ipoprotein cholesterol fractions, or fibrinogen were observed. Microalbumin uria decreased significantly on temocapril treatment (49 +/- 10 vs. 79 +/- 17 mg/24 h; p < 0.01) but not on placebo. These findings demonstrate that i n hypertensive patients with diabetes mellitus type 2, short-term treatment with temocapril is neutral to insulin sensitivity, lipoprotein metabolism, and fibrinogen, and significantly reduces microalbuminuria.