Key result
After 16 weeks of therapy, there were no statistically significant differences in insulin sensitivity (HOMA-IR) among prediabetic hypertensive patients treated with valsartan, HCTZ, or their combination.
Why the study?
Does valsartan alone or in combination with hydrochlorothiazide improve insulin sensitivity compared to hydrochlorothiazide alone in prediabetic hypertensive patients with cardiometabolic syndrome?
RCT (n=566)
Double-blind
1:1:1 ratio
Yes
Does valsartan alone or in combination with hydrochlorothiazide improve insulin sensitivity compared to hydrochlorothiazide alone in prediabetic hypertensive patients with cardiometabolic syndrome?
p-value: p=>0.05
In prediabetic hypertensive patients with cardiometabolic syndrome, adding valsartan to hydrochlorothiazide mitigates the negative metabolic effects (increased HbA1c and triglycerides) associated with diuretic monotherapy, while providing superior blood pressure control.
Valsartan does not improve insulin sensitivity over HCTZ; confirms neutral HOMA-IR effect while supporting combination BP control in cardiometabolic syndrome.
Hypertensive patients with the cardiometabolic syndrome (CMS) are at increased risk for type 2 diabetes and cardiovascular disease. The authors examined effects of valsartan and hydrochlorothiazide (HCTZ) combined and alone on insulin sensitivity (using homeostasis model assessment-insulin resistance [HOMA-IR]), and inflammatory/metabolic biomarkers in prediabetic hypertensive persons with CMS. Eligible patients entered 16-week therapy with valsartan 320 mg/d (n=189), HCTZ 25 mg/d (n=190), or valsartan/HCTZ 320/25 mg/d (n=187). At the end point, there were no statistically significant differences in HOMA-IR among the 3 groups. HCTZ significantly increased hemoglobin A(1c) and triglyceride concentrations and lowered serum potassium levels vs valsartan. HCTZ also increased plasma aldosterone and C-reactive protein levels. Blood pressure reduction and blood pressure control rates were highest with valsartan/HCTZ. There were no differences between combination valsartan/HCTZ or monotherapies on a measure of insulin sensitivity; however, the negative metabolic effects of HCTZ (increase in triglyceride and hemoglobin A(1c) values) were absent with valsartan/HCTZ, indicating an ameliorating effect of valsartan on these measures.
No takes yet. Share an insight, caveat, or question.
Zappe et al. (2008) conducted an RCT in Prediabetic hypertension with cardiometabolic syndrome (n=566). Valsartan, hydrochlorothiazide (HCTZ), or their combination vs. Active comparators (3-arm trial) was evaluated on Change in HOMA-IR value from baseline to week 16 (p=>0.05). After 16 weeks of therapy, there were no statistically significant differences in insulin sensitivity (HOMA-IR) among prediabetic hypertensive patients treated with valsartan, HCTZ, or their combination.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: