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Discrepancy between improvement of insulin sensitivity and that of arterial endothelial function in patients

Hirofumi Tomiyama1, Minoru Yambe, Jiko Yamada

  • 1Second Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.

Journal of Hypertension
|March 14, 2007
PubMed
Abstract

Insights

Candesartan improved insulin sensitivity in hypertensive patients by reducing C-reactive protein (CRP) and improving endothelial function (END). Amlodipine only improved END, suggesting anti-inflammatory effects contribute to candesartan

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Pharmacology

Background:

  • Hypertension is associated with insulin resistance and endothelial dysfunction.
  • Angiotensin II receptor blockers and calcium-channel blockers are common antihypertensive treatments.
  • The impact of these treatments on insulin sensitivity, endothelial function, and inflammation markers requires further investigation.

Purpose of the Study:

  • To evaluate if improvements in insulin sensitivity in hypertensive patients treated with candesartan or amlodipine are linked to enhanced endothelial function (END) or reduced high-sensitive C-reactive protein (CRP).
  • To compare the effects of candesartan and amlodipine on insulin resistance, endothelial function, and CRP levels.

Main Methods:

  • A randomized trial involving 71 hypertensive patients without target organ damage.
  • Patients received either candesartan (8 mg/day) or amlodipine (5 mg/day) for 8 months.
  • Measurements included the homeostasis model assessment index of insulin resistance (HOMA-IR), plasma CRP, and endothelial function (END) assessed by forearm blood flow during reactive hyperemia.

Main Results:

  • Both candesartan and amlodipine significantly improved endothelial function (END).
  • Only candesartan significantly reduced plasma CRP and the HOMA-IR index (insulin resistance).
  • In the candesartan group, the reduction in HOMA-IR was independently correlated with the reduction in CRP, but not with the improvement in END.

Conclusions:

  • Improved endothelial function alone may not fully explain the enhanced insulin sensitivity observed with antihypertensive medications.
  • The anti-inflammatory effects of candesartan, evidenced by reduced CRP levels, likely contribute to its beneficial impact on insulin sensitivity.
  • These findings suggest that targeting inflammation may be a valuable strategy in managing insulin resistance in hypertensive patients.

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