What question did this study set out to answer?

To evaluate whether antihypertensive treatment effects on left ventricular mass relate to changes in glucose and insulin metabolism in obese, insulin-resistant individuals.

October 10, 2000CirculationOpen Access

Effects of Antihypertensive Therapy on Glucose and Insulin Metabolism and on Left Ventricular Mass

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Why the study?

Does atenolol compared to perindopril affect glucose and insulin metabolism and left ventricular mass in obese, nondiabetic hypertensive patients?

Key Points

To evaluate whether antihypertensive treatment effects on left ventricular mass relate to changes in glucose and insulin metabolism in obese, insulin-resistant individuals.
Randomized trial of 21 obese, nondiabetic hypertensive adults (mean age 55±12 years, BMI 32.8±5.0 kg/m²) allocated to atenolol (n=11) or perindopril (n=10).
Assessed echocardiographic left ventricular mass indexed to height (LVM/height) and glucose and insulin metabolism via a 3-hour intravenous glucose tolerance test following a 4-to-6-week washout and 6 months of treatment.
Both treatments achieved significant and comparable blood pressure reductions (atenolol: 149±13/98±4 to 127±8/82±6 mm Hg; perindopril: 148±9/98±4 to 129±9/82±6 mm Hg; P=0.002).
Atenolol worsened fasting glucose (5.3±0.9 to 6.0±1.5 mmol/L; P=0.003), fasting insulin (121±121 to 189±228 pmol/L; P=0.03), and other metabolic measures (P<0.05), whereas perindopril did not alter glucose or insulin metabolism.
Perindopril significantly decreased LVM/height from 120±13 to 111±19 g/m (P=0.04), whereas atenolol showed no significant change (119±12 to 120±17 g/m; P=0.8).

Structured PICO

Does atenolol compared to perindopril affect glucose and insulin metabolism and left ventricular mass in obese, nondiabetic hypertensive patients?

Population

21 obese, nondiabetic hypertensive adults (mean age 55+/-12 years, BMI 32.8+/-5.0 kg/m2) free of coronary or valvular heart disease, with normal LV function.

Intervention

Atenolol for 6 months

Comparator

Perindopril for 6 months

Outcome

Echocardiographic left ventricular mass corrected for height (LVM/height) and glucose and insulin metabolism (GIM) at 6 monthssurrogate

In obese hypertensive patients, perindopril provides similar blood pressure control to atenolol but with a more favorable metabolic profile and significant regression of left ventricular mass.

Discussion

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Implication

Perindopril may be preferred over atenolol in obese nondiabetic hypertensives for LVM regression without metabolic harm; extends ACEI vs beta-blocker comparisons in this group.

Cite This Study

Kuperstein et al. (2000) studied this question.

synapsesocial.com/papers/6a73eff41690e6770ff15d87 https://doi.org/10.1161/01.cir.102.15.1802

Topics

Hypertension management

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Implication

Perindopril may be preferred over atenolol in obese nondiabetic hypertensives for LVM regression without metabolic harm; extends ACEI vs beta-blocker comparisons in this group.

Effects of Antihypertensive Therapy on Glucose and Insulin Metabolism and on Left Ventricular Mass

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Effects of Antihypertensive Therapy on Glucose and Insulin Metabolism and on Left Ventricular Mass

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider