Interference on metabolism induced by muzolimine and chlorthalidone in type II hypertensive diabetics

There is a very high prevalence of hypertension in diabetic subjects, which makes it necessary to use an antihypertensive drug with the least possible metabolic interference. For example, in the early phase of hypertension, diuretics usually worsen the metabolic equilibrium. According to recent reports, a new diuretic, muzolimine (MZ), which acts on the loop of Henle, seems to present a minor effect on carbohydrate metabolic balance. In order to determine whether this assumption was correct or not, we carried out a clinical trial on 26 type II (non-insulin-dependent) diabetics, in fairly good metabolic control and with moderate hypertension (orthostatic diastolic pressure from 100 to 115 mmHg), comparing the effect of MZ with those of chlorthalidone (CL). According to a randomized, single-blind cross-over design, the patients were treated with MZ (20 mg/day) or CL (50 mg/day) for the duration of 4 weeks. After the treatment period with the first drug, there was a 2 week wash-out period on placebo (PL) before the second drug was given. During the study, a set of metabolic and non-metabolic parameters was monitored, as were the clinostatic and orthostatic blood pressure values. The results show that the antihypertensive effect of the two drugs was the same (both caused a more than 10% decrease in systolic and diastolic blood pressure). No significant changes in plasma electrolyte levels occurred. There was a significant (p less than 0.05) increase in urinary aldosterone excretion after CL (20.7 +/- 11 micrograms/24 hours vs. 13.3 +/- 8.5 after PL, and 14.5 +/- 7.2 after MZ) (mean values +/- standard deviations).(ABSTRACT TRUNCATED AT 250 WORDS)