Candesartan, an angiotensin II receptor blocker, improves left ventricular hypertrophy and insulin resistance

A growing body of evidence indicates that the renin-angiotensin system and insulin resistance play crucial roles in left ventricular hypertrophy (LVH) in patients with essential hypertension (EH). Angiotensin II receptor blockers (ARB) have been reported to regress LVH and improve insulin resistance. We tested the hypothesis that candesartan, an ARB, could regress LVH, in association with improvement of insulin resistance in EH patients. The study participants were nondiabetic and never-treated EH patients (n = 10). Candesartan was administered at a mean final dose of 10.4 +/- 2.1 mg/d for 24 weeks. Candesartan treatment resulted in a significant decrease of systolic and diastolic blood pressures, LV mass index (LVMI), homeostasis model assessment (HOMA) index, and plasma brain natriuretic peptide (BNP). A significant correlation was observed between the percent decrease in LVMI and that of both the HOMA index (r = 0.83, P <.001) and BNP (r = 0.71, P <.005). Stepwise regression analyses revealed that the percent decrease of HOMA index was an independent predictor for both percent decrease in LVMI and plasma BNP. Our findings suggest that pharmacological blockade of angiotensin II receptors by candesartan could improve LVH in never-treated EH patients, which may relate to the improvement of insulin resistance.