Effects of antihypertensive therapy on glucose and insulin metabolism and on left ventricular mass - A randomized, double-blind, controlled study of 21 obese hypertensives

Background-Glucose and insulin levels are associated with left ventricular mass (LVM) in insulin-resistant individuals. Antihypertensive drugs have di fferent effects on glucose and insulin metabolism (GIM) and on LVM. To eval uate whether the effects of antihypertensive therapy on LVM are associated with its effects on CIM, we compared the effects of atenolol and perindopri l on these parameters in a group of insulin-resistant, obese hypertensives. Methods and Results-A total of 21 obese, nondiabetic hypertensives who were aged 55 +/- 12 years, had a body mass index of 32.8+/-5.0 kg/m(2), were fr ee of coronary or valvular heart disease, and had normal LV function were r andomized to treatment with atenolol (n=11) or perindopril (n=10). Echocard iographic LVM corrected for height (LVM/height) and GIM (3-hour intravenous glucose tolerance test) were measured after 4 to 6 weeks of washout and 6 months of treatment. Baseline characteristics were similar in both groups. Atenolol and perindopril effectively reduced blood pressure (from -49+/13/9 8+/- to 127+/-8/82+/-6 mm Hg and from 148+/-9/98+/-4 to 129+/-9/82+/-6 mm H g, respectively, for the atenolol and perindopril groups; P=0.002). Atenolo l significantly worsened GIM parameters, fasting glucose levels (5.3+/-0.9 to 6.0+/-1.5 mmol/L: P=0.003), fasting insulin levels (121+/-131 to 189+/-2 28 pmol/L; P=0.03), and most other relevant metabolic measures (P<0.05 for all). Perindopril did not affect GIM. Atenolol did not affect LVM/height (1 19+/-12 to 120+/-17 g/m; P=0.8), whereas perindopril significantly reduced LVM/height (120+/-13 to 111+/-19 g/m; P=0.04). Conclusions-In obese, hypertensive individuals, adequate and similar blood pressure control was achieved with perindopril and atenolol. However, perin dopril but not atenolol was associated with a more favorable GIM profile an d led to a significant regression of LVM.