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Doxazosin therapy in the treatment of diabetic hypertension
1Department of Therapeutics, Charing Cross and Westminster Medical School, London, England.
Insights
Controlling blood sugar alone does not reduce cardiovascular disease in patients with non-insulin-dependent diabetes mellitus (NIDDM). Antihypertensive drugs like doxazosin may improve lipid profiles and cardiovascular outcomes in these patients.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Cardiovascular disease (CVD) remains a significant concern in non-insulin-dependent diabetes mellitus (NIDDM), with hyperglycemia control alone insufficient to reduce incidence.
- Hypertension and dyslipidemia are key contributors to macrovascular complications in NIDDM patients.
- The choice of antihypertensive medication in NIDDM is often based on extrapolated data due to a lack of large-scale trials in diabetic populations.
Purpose of the Study:
- To evaluate the impact of antihypertensive therapy on lipid profiles in patients with NIDDM.
- To compare the effects of doxazosin and atenolol on metabolic parameters in NIDDM.
Main Methods:
- Review of two short-term studies assessing doxazosin's effects on blood pressure and lipid profiles in NIDDM.
- Comparison of doxazosin's effects with atenolol's effects on glycemic control, lipids, and lipoproteins.
Main Results:
- Doxazosin treatment significantly reduced blood pressure in NIDDM subjects, accompanied by favorable changes in serum lipid profiles.
- Atenolol treatment demonstrated adverse effects on glycemic control, lipids, and lipoproteins.
- Doxazosin therapy showed a trend towards correcting lipoprotein metabolism disturbances characteristic of NIDDM.
Conclusions:
- Effective blood pressure reduction with doxazosin, coupled with potential improvements in lipid metabolism, may be crucial for mitigating long-term cardiovascular disease risk in NIDDM.
- Doxazosin appears to be a favorable antihypertensive choice for NIDDM patients, considering its metabolic benefits beyond blood pressure control.
Abstract:
The incidence of cardiovascular disease in non-insulin-dependent diabetes mellitus (NIDDM) has not been reduced by the control of hyperglycemia alone. Hypertension and dyslipidemia may be the major determinants of macrovascular disease in these patients. With the high prevalence of hypertension in NIDDM, antihypertensive drugs are likely to be important determinants of an atherogenic lipid profile. To date, there is no completed major randomized controlled trial of antihypertensive treatment outcome in a diabetic population, and as such, drug choice for the treatment of diabetic hypertension is often based on evidence extrapolated from studies in nondiabetic groups. However, two short-term studies have assessed the effects of doxazosin antihypertensive therapy in subjects with NIDDM. Both studies showed that the significant reduction in blood pressure with doxazosin treatment was associated with favorable effects on the serum lipid profile. In one study, contrasting adverse effects of atenolol treatment on glycemic control, lipids, and lipoproteins were observed. Doxazosin therapy was associated with a trend toward correcting the disturbances of lipoprotein metabolism characteristic of NIDDM. These metabolic effects, combined with effective lowering of blood pressure by doxazosin, may be important determinants of cardiovascular disease in the long term.