Abstract
Objective: To evaluate the effects of canrenone compared to hydrochlorothiazide in addition to sartans on glycemia, lipid profile, potassium, aldosterone and renal function in hypertensive, diabetic patients. Design and method: We enrolled 182 Caucasian patients affected by hypertension and type 2 diabetes mellitus. Enrolled patients were already in treatment with sartans at stable doses; at baseline they were randomized to add canrenone, 50 mg once a day, or hydrochlorothiazide 12,5 mg once a day for 12 months. Patients not reaching blood pressure target after 6 months (blood pressure < 140/85 mmHg), were up-titrated to canrenone 100 mg or hydrochlorothiazide 25 mg once a day. We evaluated at the baseline, and after 6 and 12 months, these parameters: systolic (SBP) and diastolic blood pressure (DBP), body weight, body mass index (BMI), fasting plasma glucose (FPG), post-prandial glucose (PPG), fasting plasma insulin (FPI), homeostasis model assessment insulin (HOMA-IR), lipid profile, potassium, plasma aldosterone, estimated glomerular filtration rate. Results: We observed a significant similar decrease of SBP and DBP with both canrenone and hydrochlorothiazide after 6, and 12 months, without differences between groups. Canrenone gave a significant decrease of FPG, PPG, FPI, and HOMA index compared to baseline, while there was a significant increase of the same parameters with hydrochlorothiazide. Moreover, values recorded with canreone were lower compared to the ones recorded with hydrochlorothiazide. No variations of lipid profile were recorded with canrenone, while there was a worsening of total cholesterol and triglycerides with hydrochlorothiazide. Potassium levels were decreased, and uric acid levels increased by hydrochlorothiazide, but not by canrenone that had a neutral effect on these parameters. We recorded a slight decrease of estimated glomerular filtration rate with hydrochlorothiazide, and an improvement with canrenone. Plasma aldosterone levels were decreased by canrenone and increased by hydrochlorothiazide. Conclusions: Despite giving similar blood pressure, canrenone seems to be more effective than hydrochlorothiazide in improving metabolic parameters such as glycemia, insulinemia, and uric acid levels, and in improving estimated glomerular filtration rate.
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