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Metabolic Effects of Hydrochlorothiazide and Enalapril During Treatment of the Hypertensive Diabetic PatientEnalapril for Hypertensive Diabetics
Melvin J. Prince, MD;
Charles A. Stuart, MD;
Marci Padia, RN;
Zoltan Bandi, PhD;
O. Bryan Holland, MD
Arch Intern Med. 1988;148(11):2363-2368.
Abstract
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• To determine the effect of enalapril maleate and low-dose hydrochlorothiazide therapy on blood pressure and glucose and lipid homeostasis in hypertensive type II diabetic patients, we treated nine of these patients sequentially with placebo, hydrochlorothiazide (25 mg/d with supplemental potassium chloride), and enalapril (10 to 20 mg/ d). Sitting blood pressure fell significantly and to comparable levels with both hydrochlorothiazide and enalapril monotherapy. Enalapril monotherapy was associated with a slight, but not significant, fall in fasting blood glucose levels and with a significant fall in hemoglobin A1c levels. This improved glucose homeostasis could not be explained satisfactorily by changes in peripheral insulin sensitivity or hepatic glucose output, determined with the euglycemic clamp technique, or by changes in fasting serum insulin levels or monocyte insulin binding. In these low doses, hydrochlorothiazide did not worsen glucose homeostasis. Serum total cholesterol levels were significantly lower with enalapril therapy than with hydrochlorothiazide therapy or with placebo, and serum high-density lipoprotein cholesterol and triglyceride levels did not change significantly with either treatment. Thus, by providing effective blood pressure control and beneficial metabolic effects, enalapril therapy appears ideal for treatment of hypertension in diabetic patients. Similarly, low-dose hydrochlorothiazide therapy appears to have fewer metabolic complications in these patients and is, therefore, a logical alternative to substitute for, or add to, enalapril therapy.
(Arch Intern Med 1988;148:2363-2368)
Author Affiliations
From the Departments of Internal Medicine (Drs Prince, Stuart, and Holland and Ms Padia) and Pathology (Dr Bandi), University of Texas Medical Branch at Galveston. Dr Prince is now with the Department of Medicine, Oregon Health Sciences University, Portland, and the Endocrinology Section, Portland (Ore) Veterans Administration Medical Center.
Footnotes
Accepted for publication June 7, 1988.
Reprints not available.
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