1. ¹Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
2. ²Department of Cardiology, Ullevaal University Hospital, Oslo, Norway
3. ³Merck & Co., Whitehouse Station, New Jersey, USA
4. ⁴MSD AS, Drammen, Norway
5. ⁵Department of Nephrology, Ullevaal University Hospital, Oslo, Norway
6. ⁶Department of Cardiology, Ullevaal University Hospital, Oslo, Norway

Correspondence: Dr TA Aksnes, Department of Cardiology, Ullevaal University Hospital, N-0407 Oslo, Norway. E-mail: TonjeAmb.Aksnes@ulleval.no

Received 20 March 2006; Revised 19 June 2006; Accepted 19 July 2006; Published online 21 September 2006.

Abstract

We aimed to compare the effects of two different vasodilating principles, angiotensin II-receptor blockade and calcium channel blockade, on peripheral insulin-mediated glucose uptake in patients with hypertension and other cardiovascular risk factors. Twenty-one hypertensive patients (11 women and 10 men) with mean age 58.6 years (range 46–75 years), body mass index 29.21.0 kg/m² and blood pressure 1603/962 mm Hg entered a 4-week run-in period with open-label amlodipine 5 mg. Thereafter they were randomized double-blindly to additional treatment with amlodipine 5 mg or losartan 100 mg. After 8 weeks of treatment, all patients underwent clinical examination and laboratory testing, and 17 of them underwent a hyperinsulinaemic isoglycaemic glucose clamp. After a 4-week open-label wash-out phase, the participants crossed over to the opposite treatment regimen and final examinations with hyperinsulinaemic isoglycaemic glucose clamp after another 8 weeks. Blood pressure was lowered to the same level in both treatment periods. The glucose disposal rate was significantly higher after treatment with losartan 100 mg+amlodipine 5 mg compared to amlodipine 10 mg (4.90.4 vs 4.20.5 mg/kg/min, P=0.039). Thus our data suggest that angiotensin II-receptor blockade with losartan improves glucose metabolism at the cellular level beyond what can be expected by the vasodilatation and blood pressure reduction alone.