Treatment of systemic hypertension in insulin-treated diabetes mellitus with rilmenidine

Abstract

The effects of a new α 2 agonist (S 3341 or rilmenidine) on blood pressure (BP), glycemie control, lipid metabolism and renal function were investigated during a 16-week open study in 29 insulin-treated diabetic patients with mild to moderate hypertension. There were 17 men and 12 women aged 50.9 ± 2.2 years (mean ± standard error of the mean). Duration of diabetes and insulin therapy was 218 ± 24 and 143 ± 30 months. After 2 weeks of placebo, systolic and diastolic BP was 165 ± 3 and 97 ± 0.5 mm Hg, respectively (supine). Rilmenidine (S 3341) given alone at daily doses of 1 or 2 mg according to the clinical response led to a prompt and sustained decrease of systolic and diastolic BP (159 ± 4 and 88 ± 1 mm Hg after 2 weeks; 149 ± 3 and 85 ± 1 mm Hg after 12 weeks; p < 0.01). Seventeen patients (59%) had normal BP (systolic BP < 160; diastolic BP < 90 mm Hg, supine) after 12 weeks of S 3341. Diuretics were associated with S 3341 for the nonresponders at week 12; this led to normalization of BP in 90% of the patients at the end of the study. Glycemic control was assessed by home glucose monitoring (5 determinations/1 day per week), 24-hour glucosuria and postprandial plasma glucose at the outpatient clinic (n = 7) as well as by the measurement of the glycosylated hemoglobin. None of these parameters was significantly affected by S 3341. Plasma total, low-density lipoprotein and high-density lipoprotein cholesterol as well as triglycerides remained unchanged throughout the study. No modification of proteinuria or microalbuminuria was observed. Thus, S 3341 represents an effective and safe treatment for mild and moderate hypertension in insulin-treated diabetic patients without affecting their blood glucose control.