Effect of losartan and ramipril on plasma glucose, insulin, aldosterone and left ventricular mass in obese hypertensives

ABSTRACT

It has been proposed that renin angiotensin system [RAS] plays a pivotal and perhaps obligatory role in the initiation and progression of ventricular hypertrophy. Glucose and insulin level are associated with left ventricular mass [LVM] in insulin resistant individuals. Antihypertensive drugs always have ditferent effects on glucose insulin levels, RAS and on LVM. To evaluate whether the effect of antihypertensives [Losartan or Ramipril] on LVM are associated with its effects on plasma glucose, insulin and aldosterone we compared their effects on these parameters in a group of insulin resistant, obese hypertensive patients. A total of 20 obese, non diabetic hypertensives who were 45 +/- 4 years had a body mass index of 31.5 +/- 2.5 Kg/m2, were free of coronary or valvular heart disease and had normal left ventricular [LV] function were randomized to treatment with losartan , 50mg daily [n=10]or ramipril 5 mg daily [n=10]. Echocardiograpic left ventricular mass [LVM] corrected for height [LVM/height] and plasma aldosterone [PA] were measured after 4 weeks of washout and 6 months of treatment. Baseline characteristics were similar in both groups. Losartan and ramipril effectively reduced blood pressure while both did not affect significantly fasting plasma glucose or insulin levels. Both ramipril and losartan significantly reduced LVM/ height. In obese hypertensive individuals adequate and similar blood pressure control was achieved with losartan and ramipril, also, in obese hypertensive patients both losartan and ramipril led to a significant regression of left ventricular mass associated with significant decreased plasma aldosterone level