Treatment of Hypertension in Diabetic Patients withAngiotensin-converting Enzyme Inhibitor by Trandolapril - Multicentric Study

Overview

Subjects with diabetes mellitus (DM) are high-risk patients because of the cardiovascular morbidityand mortality. A one-year open clinical prospective study took place in 7 centres in the Czechand Slovak Republic in 1996 - 1997. Aim of the study was treatment of hypertension in patientswith DM of both types by the ACE inhibitor trandolapril in dose of 2 - 4 mg, possibly in combinationwith the calcium channel blocker verapamil - 240 mg. The investigation was completed by 79patients (60 patients with DM type 2 and 19 with DM type 1). All patients achieved the targetblood pressure which in 1997 was also for patients with DM less than 140/90 mm Hg. As good as20 % of the patients achieved these values when treated with 2mgtra ndolapril, 52 % ona dose of 4mgand 23 % after combined treatment. Only 25 % of the patients achieved values lower than130/85 mm Hg, as recommended in the contemporary recommendatins "Prevention of ischaemicheart disease in adult age" published in 1998.On comparison of other risk factors in groups of patients with a BP below 130/85 mm Hg andhigher than this borderlimit line it was revealed that one-year treatment of hypertension withtrandolapril - 4 mgalo ne or combined with verapamil 240 mgled to a greater reduction of thepulse rate, fastinginsu lin level, hematicrit and triglycerides and to an increase of HDL-cholesterol.This study revealed that systematic treatment of hypertension by the above mentioned drugs inpatients with DM is effective and well tolerated. In addition to reduction of the blood pressure theactivity of the sympathetic nervous system was reduced and some metabolic parameters improved.

Key words:
Arterial hypertension - Diabetes mellitus - Insulin resistance - Sympathetic nervousactivity