lisinopril and Metabolic-Syndrome

Hypertension is a highly prevalent disease and a strong risk factor for cardiovascular disease in industrialized countries in Europe and North America. About 40-50% of hypertensive patients have some other cardiovascular risk factors as smoking, dyslipidemia, glucose intolerance, metabolic syndrome and diabetes. The realization of optimal therapy of these patients is a difficult task, and reaching target blood pressure values is almost impossible by monotherapy. It was realized that the simultaneous normalization of blood pressure and that of abnormal lipid profile with 2-3 or more drugs have great importance for preventing atherosclerotic complications.We started an open-formed study with about 1000 hypertensive patients complicated with dyslipidemia, visceral obesity, metabolic syndrome and diabetes type 2. The base of our therapeutic strategy was a typical poly-pharmacologic treatment with ACE inhibitor (lisinopril), calcium antagonist (amlodipine), statin (atorvastatin) and antiplatelet therapy (if it was necessary).

Topics: Adult; Aged; Amlodipine; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Atorvastatin; Biomarkers; Blood Pressure; Calcium Channel Blockers; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Female; Heptanoic Acids; Humans; Hungary; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hyperlipidemias; Hypertension; Hypolipidemic Agents; Incidence; Lisinopril; Male; Metabolic Syndrome; Middle Aged; Prevalence; Pyrroles; Risk Factors

The role of the RAAS in development and maintenance of blood pressure is well established. In addition, the deleterious effects of angiotensin II on the heart, vasculature, and kidneys have been clearly defined. There seems to be a close relationship between endothelial dysfunction, insulin resistance (a precursor to diabetes and coronary artery disease) and angiotensin II. The signaling pathways for insulin in the vascular wall interacts with the angiotensin signaling, giving rise to potential mechanisms for development of diabetes and resulting harmful effects. A large number of clinical trials using ACE inhibitors or ARBs have shown significant reduction in secondary endpoints in the development of new onset of diabetes. Ongoing prospective studies involving ARBs (eg, the Nateglinide and Valsartan Impaired Glucose Tolerance Outcomes Research trial) and ACE inhibitors (eg, the Diabetes Re-duction Assessment with Ramipril and Rosiglita-zone Medication trial) are testing the ability of certain agents to prevent type 2 diabetes. In the meantime, it is important to recognize insulin resistance and metabolic syndrome as entities that increase the risk for cardiovascular disease. In addition to lifestyle modifications, managing endothelial dysfunction and protecting the vasculature will help prevent diabetes and cardiovascular disease.

Topics: Angiotensin-Converting Enzyme Inhibitors; Diabetes Mellitus, Type 2; Endothelium, Vascular; Humans; Insulin Resistance; Life Style; Lisinopril; Metabolic Syndrome; Renin-Angiotensin System; Risk Factors

The present study was planned to focus on comparative effects of telmisartan vs lisinopril on blood pressure in patients of metabolic syndrome. The study was carried out on 62 patients of metabolic syndrome from Dec 2010 to Oct 2012 in OPD of Institute. There were two groups, A and B. Group A- Telmisartan (31 patients) and Group B- Lisinopril (31 patients) receiving Telmisartan 40 mg and lisinopril 5 mg orally once a day respectively for 12 weeks. The diagnosis of essential hypertension was made by the physician based on two measurements of blood pressure on two different occasions using auscultatory method and was done at initial stage and repeated after 6 weeks and 12 weeks of treatment in Group A and Group B patients.. Our study found that telmisartan or lisinopril treatment for 12 weeks leads to statistically significant (p<0.001) reduction in both SBP and DBP at 6 and 12 weeks when compared with baseline, whereas comparison between telmisartan and lisinopril treatment failed to show any statistically significant effect.. Treatment of metabolic patients with telmisartan or lisinopril for the management of hypertension reduced both Systolic blood pressure (SBP) as well as Diastolic blood pressure (DBP) statistically significantly during 12 weeks treatment. However, telmisartan and lisinopril treatment were found effective.

Topics: Adult; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Benzimidazoles; Benzoates; Blood Pressure; Female; Humans; Lisinopril; Male; Metabolic Syndrome; Middle Aged; Prospective Studies; Telmisartan

Metabolic syndrome is common in patients with hypertension and increases the risk of developing diabetes mellitus. The objective of this study (the MARCADOR study) was to compare the effects of manidipine 20  mg with the extemporary combination of manidipine 10  mg/lisinopril 10  mg, amlodipine 10  mg and telmisartan 80  mg on insulin sensitivity, as well as metabolic, inflammatory and prothrombotic markers, in hypertensive non-diabetic patients with metabolic syndrome.. This study had a prospective, randomized, open-label, blinded endpoint (PROBE) design. A total of 120 patients aged 35-75 years with stage I-II essential hypertension (systolic blood pressure [BP] 140-179  mmHg, diastolic BP 90-109  mmHg) and metabolic syndrome were recruited from general practitioner clinics in Northern Gran Canaria Island, Spain and randomized to receive amlodipine 10  mg (n = 30), telmisartan 80  mg (n = 30), manidipine 20  mg (n = 30) or (low-dose) manidipine 10  mg/lisinopril 10  mg (n = 30), all administered once daily. At baseline and after 14 weeks of treatment, BP, insulin sensitivity, lipid profile, and albumin and metanephrin excretion as well as several other metabolic, inflammatory, prothrombotic and growth/adhesion markers were measured. The primary endpoint was the change in insulin sensitivity.. A total of 115 patients completed the study. All treatments significantly lowered BP from baseline. Compared with amlodipine, manidipine had significantly superior effects (p < 0.05) on insulin resistance (-26.5% vs -3.0%), albumin/creatinine ratio (-28.2% vs -3.6%), low-density lipoprotein (LDL) cholesterol (-6.8% vs +1.7%), and several other metabolic, inflammatory and prothrombotic markers. Manidipine was associated with a slightly greater increase in insulin sensitivity than manidipine/lisinopril, but manidipine/lisinopril was significantly more effective than manidipine and telmisartan for improving a number of metabolic, inflammatory, prothrombotic and growth/adhesion markers. Amlodipine was associated with a significantly greater incidence of adverse effects compared with telmisartan, manidipine and manidipine/lisinopril (26.7% vs 3.3%, 3.3% and 13.3%, respectively).. In patients with hypertension and metabolic syndrome, manidipine, both alone and in combination with the ACE inhibitor lisinopril, is significantly superior to amlodipine for improving insulin sensitivity as well as several metabolic, inflammatory and prothrombotic markers. Furthermore, the combination of manidipine and lisinopril appears to have greater efficacy than manidipine alone and telmisartan with respect to the improvement of metabolic, inflammatory and prothrombotic markers.

Topics: Adult; Aged; Amlodipine; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Benzimidazoles; Benzoates; Biomarkers; Blood Pressure; Dihydropyridines; Drug Combinations; Female; Humans; Hypertension; Insulin Resistance; Lisinopril; Male; Metabolic Syndrome; Middle Aged; Nitrobenzenes; Piperazines; Prospective Studies; Spain; Telmisartan

Hypertension is a highly prevalent disease and a strong risk factor for cardiovascular disease in industrialized countries in Europe and North America. About 40-50% of hypertensive patients have some other cardiovascular risk factors as smoking, dyslipidemia, glucose intolerance, metabolic syndrome and diabetes. The realization of optimal therapy of these patients is a difficult task, and reaching target blood pressure values is almost impossible by monotherapy. It was realized that the simultaneous normalization of blood pressure and that of abnormal lipid profile with 2-3 or more drugs have great importance for preventing atherosclerotic complications.We started an open-formed study with about 1000 hypertensive patients complicated with dyslipidemia, visceral obesity, metabolic syndrome and diabetes type 2. The base of our therapeutic strategy was a typical poly-pharmacologic treatment with ACE inhibitor (lisinopril), calcium antagonist (amlodipine), statin (atorvastatin) and antiplatelet therapy (if it was necessary).

Topics: Adult; Aged; Amlodipine; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Atorvastatin; Biomarkers; Blood Pressure; Calcium Channel Blockers; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Female; Heptanoic Acids; Humans; Hungary; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hyperlipidemias; Hypertension; Hypolipidemic Agents; Incidence; Lisinopril; Male; Metabolic Syndrome; Middle Aged; Prevalence; Pyrroles; Risk Factors

To examine antihypertensive activity, heart rate variability (HRV) and carbohydrate metabolism of ACE inhibitor lisinopril in patients with metabolic syndrome (MS).. Twenty MS patients (13 females and 7 males) received lisinopril monotherapy for 12 weeks. Before the treatment and after 12 weeks of lisinopril treatment the following tests were made: office measurement of blood pressure (BP), 24-hour BP monitoring, exercise test, investigation of HRV and carbohydrate profile.. A 12-week treatment with lisinopril had high antihypertensive efficacy, its positive action on HRV and carbohydrate metabolism manifested in reduction of postprandial glycemia and insulinemia.

Topics: Adult; Aged; Angiotensin-Converting Enzyme Inhibitors; Dietary Carbohydrates; Female; Heart Rate; Humans; Hypertension; Lisinopril; Male; Metabolic Syndrome; Middle Aged

Antihypertensive drugs with favorable metabolic effects are advocated for first-line therapy in hypertensive patients with metabolic/cardiometabolic syndrome (MetS). We compared outcomes by race in hypertensive individuals with and without MetS treated with a thiazide-type diuretic (chlorthalidone), a calcium channel blocker (amlodipine besylate), an alpha-blocker (doxazosin mesylate), or an angiotensin-converting enzyme inhibitor (lisinopril).. A subgroup analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a randomized, double-blind hypertension treatment trial of 42 418 participants. We defined MetS as hypertension plus at least 2 of the following: fasting serum glucose level of at least 100 mg/dL, body mass index (calculated as weight in kilograms divided by height in meters squared) of at least 30, fasting triglyceride levels of at least 150 mg/dL, and high-density lipoprotein cholesterol levels of less than 40 mg/dL in men or less than 50 mg/dL in women.. Significantly higher rates of heart failure were consistent across all treatment comparisons in those with MetS. Relative risks (RRs) were 1.50 (95% confidence interval, 1.18-1.90), 1.49 (1.17-1.90), and 1.88 (1.42-2.47) in black participants and 1.25 (1.06-1.47), 1.20 (1.01-1.41), and 1.82 (1.51-2.19) in nonblack participants for amlodipine, lisinopril, and doxazosin comparisons with chlorthalidone, respectively. Higher rates for combined cardiovascular disease were observed with lisinopril-chlorthalidone (RRs, 1.24 [1.09-1.40] and 1.10 [1.02-1.19], respectively) and doxazosin-chlorthalidone comparisons (RRs, 1.37 [1.19-1.58] and 1.18 [1.08-1.30], respectively) in black and nonblack participants with MetS. Higher rates of stroke were seen in black participants only (RR, 1.37 [1.07-1.76] for the lisinopril-chlorthalidone comparison, and RR, 1.49 [1.09-2.03] for the doxazosin-chlorthalidone comparison). Black patients with MetS also had higher rates of end-stage renal disease (RR, 1.70 [1.13-2.55]) with lisinopril compared with chlorthalidone.. The ALLHAT findings fail to support the preference for calcium channel blockers, alpha-blockers, or angiotensin-converting enzyme inhibitors compared with thiazide-type diuretics in patients with the MetS, despite their more favorable metabolic profiles. This was particularly true for black participants.

Topics: Aged; Aged, 80 and over; Amlodipine; Antihypertensive Agents; Black People; Chlorthalidone; Double-Blind Method; Doxazosin; Female; Humans; Hypertension; Lisinopril; Male; Metabolic Syndrome; Middle Aged; Treatment Outcome; White People

To assess efficacy of monotherapy with ACE inhibitor lisinopril (diroton) or calcium antagonist amlodipine (normodipine) and their combination in patients with metabolic syndrome (MS).. The study enrolled 42 patients (30 females, 12 males) with MS. The examination at baseline and after 12 weeks of treatment included office blood pressure (BP) measurement, 24-hour BP monitoring, heart rate variability (HRV) and carbohydrate profiles estimation.. In moderate hypertension BP normalized in 40 and 44% on monotherapy with lisinopril or amlodipine, respectively, and in 78% patients given lisinopril+amlodipine. The latter combination and lisinopril monotherapy had a positive effect on HRV parameters. Lisinopril monotherapy improved carbohydrate metabolism as shown by reduction of postprandial hyperglycemia and hyperinsulinemia in MS patients.. Combined treatment with amlodipin and lisinopril is more effective than monotherapy with each of the above drugs.

Topics: Adult; Aged; Amlodipine; Angiotensin-Converting Enzyme Inhibitors; Blood Glucose; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Calcium Channel Blockers; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Follow-Up Studies; Heart Rate; Humans; Hypertension; Insulin; Lisinopril; Male; Metabolic Syndrome; Middle Aged; Treatment Outcome

In previous studies, the I1 imidazoline specific agonist rilmenidine effectively lowered office blood pressure (BP) in patients with metabolic syndrome, improved glucose metabolism and did not demonstrate unfavourable effects on plasma lipids. The aim of the present study was to investigate the effects of 12weeks therapy with rilmenidine compared with the ACE inhibitor lisinopril on ambulatory BP, plasma lipid and fasting glucose levels in women with metabolic syndrome.. Prospective randomised open-label, blinded end-points study.. Female patients (n = 51) with hypertension and other components of metabolic syndrome were treated with 1 mg rilmenidine (n = 24) or 10 mg lisinopril (n = 27), once- or twice-daily. Anthropometric measurements, office BP and heart rate (HR) measurements, ambulatory BP monitoring, lipid and fasting glucose assessment were performed before and after 12weeks of treatment. Changes in ambulatory BP and HR, including 24-h, daytime and night-time values, and in lipids and glucose levels. All changes were adjusted for baseline values using the analysis of covariance method.. Ambulatory 24-h systolic BP and diastolic BP were decreased significantly in the rilmenidine group (-11.9 +/- 1.9 and -7.7 +/- 0.8 mm Hg, p < 0.001) respectively and the lisinopril group (-11.0 +/- 1.8 and -6.7 +/- 0.7 mm Hg respectively, p < 0.001). There were no significant differences between the two groups. Rilmenidine reduced 24-h ambulatory HR (-3.6 +/- 0.8 bpm versus 0.3 +/- 0.8 bpm with lisinopril; p = 0.002). The reductions of day-time and night-time BP were also significant for both treatment groups, but the rilmenidine group demonstrated a greater decrease in night-time diastolic BP (p = 0.046). Rilmenidine significantly increased HDL cholesterol and decreased fasting glucose levels (p = 0.009 and p = 0.012, respectively). HDL cholesterol tended to increase and fasting glucose tended to decrease in the lisinopril group. However, differences between groups were not significant.. Rilmenidine has similar effects on ambulatory BP patterns in hypertensive women with metabolic syndrome as lisinopril. Rilmenidine compared with lisinopril significantly reduces ambulatory HR. In this study, rilmenidine and lisinopril demonstrate similar effects on plasma lipid and fasting glucose levels.

Topics: Adult; Aged; Analysis of Variance; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Blood Glucose; Blood Pressure Monitoring, Ambulatory; Female; Heart Rate; Hemodynamics; Humans; Hypertension; Lisinopril; Metabolic Syndrome; Middle Aged; Oxazoles; Prospective Studies; Rilmenidine; Single-Blind Method; Statistics, Nonparametric; Treatment Outcome

Topics: Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Blood Platelets; Body Mass Index; Data Interpretation, Statistical; Female; Humans; Hypertension; Lipid Peroxidation; Lisinopril; Male; Metabolic Syndrome; Middle Aged; Platelet Aggregation; Time Factors

Aim        To study the psychological continuum in elderly patients with arterial hypertension associated with metabolic syndrome during the chronotherapy with a fixed combination (FC) of amlodipine, lisinopril, and rosuvastatin.Material and methods        In the inpatient conditions, 63 patients aged 60-74 years with arterial hypertension associated with metabolic syndrome were treated with chronotherapy with a FC of amlodipine, lisinopril, and rosuvastatin (5 / 10 / 10 mg/day in the evening). These patients composed the main group. The control group (58 patients aged 60-74 years with arterial hypertension associated with metabolic syndrome) was treated with the FC of amlodipine, lisinopril, and rosuvastatin at the same dose of 5 / 10 / 10 mg/day in the morning.Results   At one year, the disorders of psychological continuum were significantly decreased with the chronotherapy (evening dosing) with the antihypertensive FC of amlodipine, lisinopril, and rosuvastatin compared to the traditional treatment (morning dosing) at the same dose of 5 / 10 / 10 mg/day in both groups. With the chronotherapeutic approach, the dynamic of cognitive disorders in patients aged 60-74 years with arterial hypertension associated with metabolic syndrome was characterized by a significant increase in the Mini-Mental-State-Examination scale score from 17.8±0.3 at baseline to 23.5±0.4 with the evening dosing (р<0.001) vs. the increase from 16.9±0.3 to 20.4±0.4 (р<0.001) with the morning dosing. The situational anxiety score decreased from 40.0±2.2 to 30.6±1.8 (р<0.05) and from 40.8±2.5 to 33.5±1.9  (р<0.05), and the trait anxiety score decreased from 48.8±2.0 to 26.4±1.9 (р<0.001) and from 44.9±1.9 to 30.7±1.7  (р<0.01) with the evening and morning dosing, respectively. Depressive disorders slightly decreased with the chronotherapy by 14.1 % vs. 7.7 % with the traditional regimen; nevertheless, they were consistent with depressive spectrum disorders in both groups.Conclusion            The study results showed a higher effectiveness of the chronotherapeutic treatment compared to the traditional treatment with FC of amlodipine, lisinopril, and rosuvastatin in arterial hypertension with metabolic syndrome.

Topics: Aged; Amlodipine; Antihypertensive Agents; Anxiety; Blood Pressure; Chronotherapy; Humans; Hypertension; Lisinopril; Metabolic Syndrome; Middle Aged; Rosuvastatin Calcium

Optimal initial antihypertensive drug therapy in people with the metabolic syndrome is unknown.. We conducted a subgroup analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) to compare metabolic, cardiovascular, and renal outcomes in individuals assigned to initial hypertension treatment with a thiazide-like diuretic (chlorthalidone), a calcium channel blocker (CCB; amlodipine), or an ACE inhibitor (lisinopril) in nondiabetic individuals with or without metabolic syndrome.. In participants with metabolic syndrome, at 4 years of follow-up, the incidence of newly diagnosed diabetes (fasting glucose >or=126 mg/dl) was 17.1% for chlorthalidone, 16.0% for amlodipine (P = 0.49, chlorthalidone vs. amlodipine) and 12.6% for lisinopril (P < 0.05, lisinopril vs. chlorthalidone). For those without metabolic syndrome, the rate of newly diagnosed diabetes was 7.7% for chlorthalidone, 4.2% for amlodipine, and 4.7% for lisinopril (P < 0.05 for both comparisons). There were no differences in relative risks (RRs) for outcomes with amlodipine compared with chlorthalidone in those with metabolic syndrome; in those without metabolic syndrome, there was a higher risk for heart failure (RR 1.55 [95% CI 1.25-1.35]). In comparison with lisinopril, chlorthalidone was superior in those with metabolic syndrome with respect to heart failure (1.31 [1.04-1.64]) and combined cardiovascular disease (CVD) (1.19 [1.07-1.32]). No significant treatment group-metabolic syndrome interaction was noted.. Despite a less favorable metabolic profile, thiazide-like diuretic initial therapy for hypertension offers similar, and in some instances possibly superior, CVD outcomes in older hypertensive adults with metabolic syndrome, as compared with treatment with CCBs and ACE inhibitors.

Topics: Aged; Amlodipine; Antihypertensive Agents; Atherosclerosis; Blood Pressure; Chlorthalidone; Cohort Studies; Coronary Disease; Female; Humans; Hypertension; Hypolipidemic Agents; Lisinopril; Male; Metabolic Syndrome; Middle Aged; Myocardial Infarction; Risk Factors

To compare effects of moxonidine and lisinopril on parameters of lipid metabolism in patients with metabolic syndrome.. Moxonidine (0.2-04 mg/day) and lisinopril (10-20 mg/day) were given to 25 and 24 patients, respectively. Blood pressure, heart rate, parameters of lipid profile and fasting blood glucose were measured before and after 12 weeks of treatment.. Antihypertensive efficacy of 2 drugs was similar. No changes of lipid profile occurred in lisinopril treated patients while significant elevation of high density lipoprotein cholesterol and tendency to lowering of triglyceride level were observed in moxonidine group.. Therapy with moxonidine was associated with favorable changes of lipid profile.

Topics: Antihypertensive Agents; Humans; Hypertension; Lipid Metabolism; Lisinopril; Metabolic Syndrome