EFFECTS OF LOSARTAN AND DILTIAZEM ON BLOOD-PRESSURE, INSULIN SENSITIVITY, LIPID PROFILE AND MICROALBUMINURIA IN HYPERTENSIVE TYPE-2 DIABETIC-PATIENTS

Objective: To investigate the effect of losartan versus diltiazem on b lood pressure, albuminuria, insulin sensitivity and lipid profile in a randomised, open study. Patients: 40 type 2 diabetic patients (57 +/- 12 years) from the Endocrinology clinic, with mild hypertension, pers istent microalbuminuria and normal renal function, were randomly admin istered losartan 50 mg/day (n = 20) or diltiazem 300 mg/day (n = 20) f or 12 weeks. After 1 month, hydrochlorothiazide 12.5mg was added if bl ood pressure was >130/85mm Hg. Outcome Measures: At baseline and after 3 months, plasma glucose, glycated haemoglobin (HbA(1C)), uric acid, lipid profile, albumin excretion rate and creatinine clearance were me asured by routine methods. Insulin sensitivity was estimated by an ins ulin suppression test, and ambulatory blood pressure was monitored for 24 hours. Results: Mean systolic blood pressure decreased from 151 +/ - 15 to 133 +/- 11mm Hg with losartan (p < 0.05) and from 153 +/- 17 t o 130 +/- 18mm Hg with diltiazem (p < 0.05). Mean diastolic blood pres sure decreased from 82 +/- 12 to 74 +/- 13mm Hg with losartan (p < 0.0 5) and from 85 +/- 13 to 72 +/- 16mm Hg with diltiazem (p < 0.05). Alb uminuria decreased from 147 +/- 56 to 121 +/- 57 mu g/min with losarta n (p < 0.05) and from 143 +/- 76 to 119 +/- 49 mu g/min with diltiazem (p < 0.05). Differences between the two treatments were not significa nt. Insulin sensitivity and lipid profile were not modified by any of the treatments and no adverse effects were reported. Conclusion: Both drugs were well tolerated and effectively reduced blood pressure and a lbuminuria, but did not modify insulin sensitivity or lipid profile.