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Treatment of hypertension in diabetic patients
A E Lambert1, M Mpoy, B Vandeleene
1Service d'Endocrinologie et Nutrition, University Hospital St. Luc, Brussels, Belgium.
Insights
Rilmenidine effectively controlled mild-to-moderate hypertension in diabetic patients on insulin. This treatment did not negatively impact blood glucose control or lipid metabolism, offering a safe therapeutic option.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- Hypertension is prevalent in diabetic patients, increasing cardiovascular and microangiopathic complication risks.
- Effective hypertension management is crucial in diabetes, but some drugs hinder glucose/lipid control or mask hypoglycemia.
- Orthostatic hypotension is a concern in diabetic autonomic neuropathy, complicating antihypertensive choices.
Purpose of the Study:
- To assess the efficacy and safety of rilmenidine in diabetic patients with mild-to-moderate hypertension.
- To evaluate rilmenidine's impact on blood glucose control, lipid metabolism, and proteinuria in this population.
Main Methods:
- A 16-week study involving 29 insulin-treated diabetic patients with mild-to-moderate hypertension.
- Rilmenidine administered as monotherapy, with diuretic addition for non-responders.
- Blood pressure, blood glucose, glycosylated hemoglobin, lipid profiles, and proteinuria monitored.
Main Results:
- Rilmenidine normalized blood pressure in 17 patients as monotherapy and in 9 additional patients when combined with a diuretic.
- No significant changes were observed in blood glucose control, glycosylated hemoglobin levels, or lipid profiles.
- No adverse effects on proteinuria or microalbuminuria were detected during the trial.
Conclusions:
- Rilmenidine provides an effective and safe treatment for mild-to-moderate hypertension in insulin-treated diabetic patients.
- The drug does not interfere with glycemic control, making it a suitable option for this patient group.
Abstract:
Hypertension, common in diabetic patients, worsens not only the risk of cardiovascular complications, but also that of microangiopathic complications (nephropathy, retinopathy) of diabetes mellitus. It is thus important to ensure the perfect control of even mild hypertension in diabetic patients. However, treatment sometimes becomes difficult given that certain categories of antihypertensive drugs interfere with blood glucose control and/or lipid metabolism, interfere with the symptomatology of hypoglycemia, or promote orthostatic hypotension, a complication of autonomic neuropathy. A study was undertaken to determine the effects of rilmenidine, administered for 16 weeks, in 29 diabetic patients treated with insulin and experiencing mild-to-moderate hypertension (supine diastolic blood pressure, 96.7 +/- 0.5 mmHg). Administered as single-drug therapy, rilmenidine rapidly normalized blood pressure (systolic blood pressure, less than 160 mmHg; diastolic blood pressure, no more than 90 mmHg--supine) in 17 patients; this persisted throughout the trial period. Addition of a diuretic after 12 weeks in the remaining 12 patients led to normalization of blood pressure in nine additional patients. Blood glucose control (evaluated at home by weekly blood glucose measurements and by glycosylated hemoglobin levels) was unaffected by treatment. Plasma levels of cholesterol (total, high-density lipoprotein and low-density lipoprotein), triglycerides and proteinuria (or microalbuminuria) showed no change during the course of the trial. In conclusion, rilmenidine offers an effective and safe treatment for mild-to-moderate hypertension in diabetic patients treated with insulin and does not interfere with their blood glucose control.