RAS BLOCKERS PLUS CCB COMBINATIONS ON HOMA-IR, HOMA-B, HOMA-S AND QUICKI INDICES IN PREDIABETIC HYPERTENSIVE PATIENTS, A RANDOMIZED 12-WEEK OPEN-LABEL COMPARATIVE STUDY

Abstract

Objective: Hypertensive patients often suffer from other metabolism related comorbidities characterized by insulin resistance (e.g., diabetes mellitus, metabolic syndrome). Dual combination treatment is advised with current treatment guidelines for the management of Hypertension. ARB or ACE-i plus CCB combinations are considered to have a beneficial effect on glucose homeostasis. We present comparative data of the effect of delapril/manidipine versus telmisartan/amlodipine versus valsartan/amlodipine combination treatments, in HOMA-IR, HOMA-B, HOMA-S and QUICKI indices before and after a 12-week treatment, in hypertensive prediabetic patients. Design and method: Data were collected from 158 patients from the outpatient clinic for patients with lipid disorders, hypertension and diabetes of our hospital, during the period 2014-2018. A total of 53 patients was randomized in the delapril/manidipine (DEL/MANI) group 30/10 mg per day while 51 patients had been randomized in the group of telmisartan/amlodipine (TEL/AMLO) 80/5mg per day and 54 patients in the valsartan/amlodipine (VAL/AMLO) 160/5 mg per day. All patients successfully completed the study. Baseline characteristics are presented in Table 1A. Results: The resulting alternations in HOMA-IR, HOMA-B, HOMA-S, QUICKI, before and after the 12-week treatment are presented on Table 1B for all treatment groups. Conclusions: comparison between the treatment groups showed a statistically significant difference in the change of HOMA-IR (from the beginning of treatment to its end) between the TEL/AMLO treatment group and the DEL/MANI treatment group (p-value<0.05), with increased insulin sensitivity in the TEL/AMLO group. Furthermore, HOMA-B was significantly increased in the DEL/MANI group compared with the TEL/AMLO group (p<0.05). No other significant changes were evident. Patients in the TEL/AMLO group had significantly lower insulin resistance as shown by the HOMA-IR index compared with the patients that received VAL/AMLO (p <0.001). Furthermore, QUICKI index was significantly increased in the TEL/AMLO group compared with the VAL/AMLO group (p<0.01).