Effects of Angiotensin Receptor Antagonist and Converting Enzyme Inhibitor on Insulin Resistance in Patients with Essential Hypertension

Objective:To explore the effect of single or combination use of angiotensin Ⅱ receptor antagonist (AT1RA) Valsartan and ACEI Ramipril on insulin resistance (IR) in patients with essential hypertension (EH) .Methods: 104 cases with mild to moderate EH were assigned into three groups randomly. One(35 cases) were treated with Valsartan 160mg, another (35cases) with Ramipril 5mg, another (34 cases) with Valsartan 80mg and Ramipril 2.5mg once daily for 12 weeks. Causal and ambulatory blood pressure were monitored through the whole therapy and indices of glucose metabolism including plasma levels of fast glucose (FBG), insulin (FINS), C peptide (CP) were determined before and after the therapy. Insulin sensitive index(ISI) was calculated. Another 30 cases of healthy people served as control group also measured the above biochemical indices. Results: After treatment with Valsartan,Ramipril or their combination, the casual and ambulatory blood pressure of patients with EH were decreased significantly (all P0.001). There was no significant difference among three subgroups in the extend of pressure decrease. After treatment, FBG levels in three observed groups showed no obvious changes(all P0.05), while levels of CP, FENS were significantly lower than those before treatment (all P0.05) . ISI increased (0.10±0.22), (0.11±0.26), (0.21±0.28) respectively in three groups. The increase of ISI in combination group was significantly larger than the other two(P0.05). Conclusion: Both Valsartan and Ramipril can improve IR in patients with EH, two drugs combination is more powerful.