Haemodynamic and metabolic effects of rilmenidine in hypertensive patientswith metabolic syndrome X. A double-blind parallel study versus amlodipine

Objective To compare the effects of rilmenidine with those of amlodipine on blood pressure, glucose metabolism, plasma lipid concentration and fibrino lysis parameters. Design A four-month randomized double-blind, parallel group study. Patients and methods Obese hypertensive patients with hypertriglyceridaemia (greater than or equal to 2.3 mmol/l) and impaired glucose tolerance (OMS- ADA) were included (n = 52). A placebo run-in period of 2 weeks was followe d by 4 months of double-blind treatment with either rilmenidine or amlodipi ne. Blood pressure was recorded using a mercury sphygmomanometer. Glucose m etabolism was evaluated by an oral glucose tolerance test. Results Of the 52 patients recruited, 47 (21 rilmenidine and 26 amlodipine) completed the 4-month treatment period. The intention-to-treat analysis sh owed a comparable reduction in systolic and diastolic blood pressure (SBP, DBP) with the two anti-hypertensive treatments (rilmenidine -13.9/-13.5 mmH g; amlodipine -17.6/-15.0 mmHg). Insulin concentrations under basal conditi ons and 2 h after a standard oral glucose load did not change significantly after treatment in both groups. Plasma glucose under basal conditions and 2 h after a standard oral glucose load as well as the area under the plasma glucose concentration curve tended to decrease in the rilmenidine group an d to increase in the amlodipine group so that the changes in these paramete rs were significantly different between the two study groups (P = 0.041, P = 0.042 and P = 0.015, respectively). Plasminogen activator inhibitor type 1 (PAI-1) antigen and PAI-1 activity were only decreased in the rilmenidine group (not statistically significant). Conclusion Our results demonstrate that rilmenidine and amlodipine have a c omparable anti-hypertensive effect but only rilmenidine is able to improve glucose metabolism. J Hypertens 18:1515-1522 (C) 2000 Lippincott Williams & Wilkins.