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Metabolic neutrality in nitrendipine therapy
M Mancini1, T Marotta, L A Ferrara
1Institute of Internal Medicine and Metabolic Diseases, 2nd Medical School, University of Naples, Italy.
Insights
Nitrendipine, an antihypertensive drug, shows metabolic neutrality. It does not worsen glucose tolerance or lipid metabolism, suggesting its usefulness in managing hypertension alongside other cardiovascular risks.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Hypertension frequently coexists with metabolic disorders like hyperlipidemia and diabetes.
- Reducing blood pressure alone is insufficient to lower mortality; cardiovascular risk factors must be addressed.
- Some antihypertensive drugs cause metabolic side effects, necessitating careful drug selection.
Purpose of the Study:
- To evaluate the metabolic effects of nitrendipine, a calcium antagonist, in hypertensive patients.
- To assess nitrendipine's impact on glucose metabolism and insulin response.
- To investigate nitrendipine's effects on lipid metabolism parameters.
Main Methods:
- Patients received nitrendipine for 2 months.
- Insulin response to intravenous glucose load was measured.
- Lipid metabolism parameters and triglyceride catabolism were assessed using a lipid emulsion (Intralipid).
Main Results:
- Nitrendipine did not alter serum insulin levels or glucose removal rates.
- No adverse changes were observed in lipid metabolism parameters.
- A significant 22% increase in Intralipid removal rate indicated improved triglyceride catabolism.
Conclusions:
- Nitrendipine exhibits metabolic neutrality, with no detrimental effects on glucose or lipid metabolism.
- The drug may favorably impact triglyceride metabolism, potentially via lipoprotein lipase activity.
- Nitrendipine's metabolic profile supports its use in comprehensive hypertension management, considering the global cardiovascular risk profile.
Abstract:
There is evidence that hypertensive patients frequently have other metabolic disorders, such as hyperlipidemia and diabetes mellitus. It is also known that the reduction in high blood pressure alone, disregarding the other cardiovascular risk factors, is unable to reduce mortality to the level of the general population. Moreover, the occurrence of metabolic side effects with some antihypertensive drugs deserves particular attention in the treatment of hypertension. Calcium antagonists seem to be devoid of untoward metabolic effects. In particular, several studies have shown that nitrendipine does not deteriorate glucose tolerance. We have evaluated the effects of nitrendipine on insulin response to i.v. glucose load: no change was observed after 2 months of treatment in both serum insulin levels and glucose percent removal rate in comparison to pretreatment values. No unfavorable change was detectable in the studies aimed at investigating the effects of nitrendipine on lipid metabolism parameters. We observed a 22% increase of the percent removal rate of a lipid emulsion (Intralipid) after nitrendipine (3.11 +/- 1.0 vs. 3.80 +/- 1.0%/min, p less than 0.03). This finding suggests a favorable effect of nitrendipine on triglyceride catabolism, possibly mediated by an interference with lipoprotein lipase activity. The metabolic neutrality of nitrendipine, therefore, leads to considering the usefulness of this drug in an antihypertensive treatment that should not disregard the global risk profile.