Differences in Glucose Tolerance Between Fixed-Dose Antihypertensive Drug Combinations in People With Metabolic Syndrome

OBJECTIVE — We sought to test the hypothesis that a fixed-dose combination of trandola-pril/verapamil-SR (T/V) is superior to a fixed-dose combination of losartan/hydrochlorothiazide (L/H) on glucose tolerance in hypertensive patients with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS — A prospective, randomized, open-label, blinded–end points design was used to assess the effects of a T/V versus L/H combination in patients with IGT and hypertension (n 240) followed for up to 1 year. Doses were titrated to a systolic blood pressure 130 mmHg. Primary outcome was change from baseline in a 2-h glucose on oral glucose tolerance test (OGTT) at study end (mean [SD] at follow-up, 46.9 13.5 weeks). Secondary outcomes included changes in insulin sensitivity, office and 24-h am-bulatory blood pressure, incidence of new-onset diabetes, lipids, and inflammatory markers. Data are expressed as means SE unless otherwise noted. RESULTS — Changes at study end were noted in 2-h OGTT glucose (T/V0.21 0.36 vs. L/H1.44 0.36 mmol/l; P 0.001) and insulin level (30.13 38.38 vs.84.86 38.33 pmol/l, respectively; P 0.025). Worsening of insulin resistance occurred by week 12 (T/V 0.000 0.001 vs. L/H0.005 0.001; P 0.016). A higher incidence of new-onset diabete