Endocrine Abstracts

In hypertensive diabetic patients, renal angiotensin system blockers are first preferred due to their antihypertensive and antiproteinuric activities. Carvedilol, a third generation beta blocker, may provide additional benefits in diabetic patients. We aimed to compare the short-term efficacy of losartan treatment alone and in combination with cilazapril or carvedilol on blood pressure, glycemic control and lipid profile in microalbuminuric type 2 diabetic patients.

Methods: The study conducted in 30 consecutive patients with type 2 diabetes mellitus and stage 1 hypertension. After 2 weeks follow-up period (Period 1), all patients received losartan 50 mg/day as a single dose for 6 weeks (Period 2). Then, patients were randomized into 3 groups at the end of 6th week. Losartan dose was increased to 100 mg/day in the first group (Group 1, n:10). Carvedilol (25 mg/day) in the second group (Group 2, n:10) and cilazapril (5 mg/day) in the third group (Group 3, n:10) was added to losartan 50 mg/day treatment for another 6 weeks (Period 3).

Results: In all three groups, effective blood pressure control was provided during losartan 50 mg administration and post-randomization treatment period. Body mass index in Group 1 significantly decreased during the losartan dose-increasing period. When the losartan dose was increased in Group 1, fasting glucose values were significantly decreased, but not in other groups. There was no significant difference in measurements of post-prandial glucose, and serum fasting insulin, fructose, lipid and apolipoprotein levels between the three groups. A1c values in the losartan group significantly decreased from baseline 8±1.2% to 7.8±1.0 at 6^th week and 7.5±0.9% at 12^th week. The reductions in A1c values of losartan plus carvedilol and losartan plus cilazapril groups were not significant (P>0.05).

Conclusion: As a result, the use of high-dose losartan in hypertensive microalbuminuric type 2 diabetic patients provided short-term more effective glycemic control when compared to carvedilol or cilazapril treatments with low-dose losartan. Significant decreases in the high dose losartan group in terms of body mass index, fasting blood glucose and A1c levels, it could explained by diet compliance and better weight control when compared with other groups.