Abstract 4435: Dysglycemia During Treatment with HCTZ in Patients with Hypertension and Metabolic Syndrome
Thiazide diuretics (TD) have been associated with an increase, and ACE inhibitors (ACEI) have been associated with a decrease in development of diabetes in patients with hypertension (HTN). However, our knowledge is incomplete with regard to early effects on dysglycemia of TD and ACEI or their combination in patients with HTN and metabolic syndrome (MetSyn). Controlled parallel study in patients (n=6) with BP ≥ 130/85 mmHg and criteria for MetSyn (NCEP). All patients were randomized to either HCTZ (H) 25mg or Trandolapril (T) 4mg qd for 6 weeks, followed by the combination for 6 weeks. Diet and exercise were constant during the study. A 75 g 2 hr oral glucose tolerance test (OGTT) was performed at baseline, 6 and 12 wks, and the area under the curve for the OGTT (AUC-OGTT) was calculated. K+ was monitored and K+ supplementation was available for patients with hypokalemia during the study. Patients were 50 (7) years old and were 83% female. At baseline BP was 146/94 (14/7) mmHg, fasting glucose (FG) 78 (5) mg/dl, 2 hr glucose 92 (37) mg/dl, triglycerides 174 (46) mg/dl, HDL 41 (9) mg/dl, waist circumference 44 (4) inches and potassium 4.1 (0.3) mmol/l. At baseline none of the patients had impaired fasting glucose (IFG) or impaired glucose tolerance. The table⇓ summarizes BP, OGTT and K+ data following treatment. No patients required potassium supplementation during the study. In 2 patients (33%), 2 hr glucose values were diagnostic of IGT after 6 weeks of H(151 and 161 mg/dl). In patients with MetSyn, treatment with just 6 weeks of a TD, either alone or in combination with ACEI worsens glucose tolerance. While ACEI improves glucose tolerance, the improvement is not maintained after the addition of TD. These pilot data warrant further investigation into the effects of TD in the growing population of patients with MetSyn and hypertension and suggest FG alone may not be adequate to monitor the adverse effect of H on dysglycemia.