ABSTRACT
BACKGROUND AND OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
Subject(s)
Antihypertensive Agents/pharmacology , Dihydropyridines/pharmacology , Hypertension/drug therapy , Lisinopril/pharmacology , Adult , Aged , Amlodipine/adverse effects , Amlodipine/pharmacology , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Antihypertensive Agents/administration & dosage , Antihypertensive Agents/adverse effects , Benzimidazoles/adverse effects , Benzimidazoles/pharmacology , Benzoates/adverse effects , Benzoates/pharmacology , Biomarkers/metabolism , Blood Pressure/drug effects , Dihydropyridines/administration & dosage , Dihydropyridines/adverse effects , Drug Combinations , Female , Humans , Hypertension/complications , Insulin Resistance , Lisinopril/administration & dosage , Lisinopril/adverse effects , Male , Metabolic Syndrome/complications , Metabolic Syndrome/drug therapy , Middle Aged , Nitrobenzenes , Piperazines , Prospective Studies , Spain , TelmisartanABSTRACT
Es bien conocido que la cirugía bariátrica no está exenta de complicaciones, en especial las técnicas de hipoabsorción. Sin embargo, en la práctica clínica la pérdida de visión por déficit de vitamina A como complicación nutricional de este tipo de cirugía es poco habitual. Presentamos el caso de una paciente de 56 años con xeroftalmía bilateral con perforación corneal del ojo izquierdo y disminución de la agudeza visual bilateral después de ser sometida a cirugía bariátrica (derivación biliopancreática tipo Scopinaro) por obesidad mórbida. A pesar del tratamiento sustitutivo con altas dosis de vitamina A, la pérdida de visión del ojo izquierdo es prácticamente total (AU)
It is well known the bariatric surgery is not without complications, particularly malabsorptive techniques. However, loss of vision due to vitamin A deficiency as a nutritional complication of this type of surgery is rare in clinical practice. We report the case of a 56-year-old woman with bilateral xerophthalmia, left corneal perforation and reduced bilateral visual acuity following bariatric surgery (Scopinaro type biliopancreatic diversion) for morbid obesity. Despite treatment with very high doses of vitamin A supplements, the loss of vision in the left eye was practically complete (AU)
