Therapeutic Research

Abstract

We have compared the effect of two antihypertensive drugs, imidapril and telmisartan, on hyperinsulinemia and steroid hormone levels in essential hypertensive patients with insulin resistance. Imidapril is the only angiotensin converting enzyme（ACE）inhibitor that is permitted to be used in treating type 1 diabetic nephropathy in Japan. Telmisartan is an angiotensin I I receptor blocker（ARB）that acts as a PPAR−γ agonist and improves insulin resistance. Twenty essential hypertensive patients with insulin resistance were randomly segregated into imidapril and telmisartan treatment groups. Blood pressure（BP）, fasting plasma glucose, HbA1c, fasting serum immunoreactive insulin（F−IRI）, insulin resistance index as assessed by homeostasis model assessment（HOMA−R）, serum dehydroepiandrosterone（DHEA）, serum DHEA−sulfate（DHEA−S）, plasma ACTH, serum cortisol, plasma renin activity and serum aldosterone were measured before and after three to six months of treatment. Both treatments lowered BP, F−IRI and HOMA−R, significantly. Serum levels of DHEA and DHEA−S increased significantly in both groups. Imidapril had the same effect on lowering BP, improving insulin resistance and increasing adrenal androgens（DHEA and DHEA−S）as telmisartan.