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    Home > Active Ingredient News > Endocrine System > When hypertension meets metabolic syndrome, this antihypertensive treatment can also reduce the occurrence of diabetes!

    When hypertension meets metabolic syndrome, this antihypertensive treatment can also reduce the occurrence of diabetes!

    • Last Update: 2021-04-20
    • Source: Internet
    • Author: User
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    *Only for medical professionals to read for reference.
    Olmesartan medoxomil/amlodipine reduces blood pressure while reducing new-onset diabetes.
    It is an ideal choice for patients with metabolic syndrome.

    Among patients with essential hypertension, the prevalence of metabolic syndrome (MetS) is very high, accounting for about 50%.
    Compared with patients without MetS, patients with hypertension and MetS not only have a higher cardiovascular risk , And the choice of antihypertensive therapy has a great impact on the risk of type 2 diabetes (T2DM).

     Specifically, compared with placebo, angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists (ACEI/ARB) can improve patients’ insulin sensitivity while reducing the risk of T2DM, while calcium channel blockade The effect of CCB is more neutral.

     In contrast to ACEI/ARB, thiazide diuretics and β-blockers may not only reduce the sensitivity of patients to insulin, but also increase the risk of T2DM.

    It can be seen that for hypertensive patients with a higher risk of cardiovascular disease and MetS, the combined application of ACEI/ARB and CCB may benefit more.

     The current domestic and international guidelines for hypertension management also point out that for most high-risk hypertensive patients, combined antihypertensive therapy may be a more appropriate choice.

    For patients with MetS, the guideline recommends the combination of ARB and low-dose thiazide diuretics or CCB.

     Since there are few previous trials on the effect of antihypertensive therapy on glucose and lipid metabolism, the OLAS study we introduce today focuses on the role of olmesartan medoxomil/amlodipine and olmesartan medoxomil/hydrochlorothiazide in patients with hypertension and MetS.
    Compare.

     Let's take a look at this research.

    Olmesartan medoxomil/amlodipine vs.
    Olmesartan medoxomil/hydrochlorothiazide, which one is better? First, olmesartan medoxomil/amlodipine and olmesartan medoxomil/hydrochlorothiazide are introduced.

    Olmesartan medoxomil is a commonly used ARB antihypertensive drug in clinical practice.
    In previous studies to verify the efficacy by monitoring 24-hour ambulatory blood pressure, the results showed that compared with other ARBs, olmesartan medoxomil has higher blood pressure stability and better performance.
    Good control of 24-hour ambulatory blood pressure.

    As a CCB drug, amlodipine has been confirmed by previous studies to have a moderate insulin sensitization effect.

     The OLAS study compared the effects of olmesartan medoxomil/amlodipine and olmesartan medoxomil/hydrochlorothiazide on inflammatory parameters [including tumor necrosis factor-a (TNF-a), C-reactive protein (CRP), human interleukin (IL) -1b, -6 and -8, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion factor-1 (VCAM-1)] and metabolic parameters (including insulin sensitivity and adiponectin), and The condition of new T2DM in patients with Mets but without diabetes was used as a secondary indicator.

     The patients recruited in this study were 25-75 years old, with stage I-II hypertension, with systolic blood pressure ranging from 140-179 mmHg, meeting the requirements of men’s waist circumference of >94 cm and women’s waist circumference of >80 cm, according to the International Diabetes Federation The definition of MetS meets at least the following two criteria: triglycerides>1.
    7 mmol-1; male high-density lipoprotein cholesterol (HDL-C) <1.
    03 mmol-1, female <1.
    29 mmol-1; fasting blood glucose>5.
    6 mmol- 1.
    Blood pressure>135/80 mmHg.

    At the same time, if the patient has been treated with antihypertensive therapy before the trial, it should be stopped 3-5 weeks before being included in the study.

     The study excluded patients who had previously suffered from T2DM, and conducted a standard oral glucose tolerance test on patients with fasting blood glucose >5.
    6 mmol-1 to exclude patients with T2DM who may have been missed.

    A total of 256 patients were screened, and finally 120 were randomly assigned to join the trial.

    At the baseline examination, the average age of the patients was 59.
    3±8.
    1 years, 55% of the patients were women, and the average body mass index was 31.
    2±3.
    7 kg·m2.

    60 cases in each group.

    Figure 1 Flow chart of the OLAS study for lowering blood pressure while reducing inflammation indicators and new-onset diabetes.
    Olmesartan medoxomil/amlodipine is the best choice for lowering blood pressure.
    The results show that compared with baseline, olmesartan medoxomil/amlodipine group and olmesartan The blood pressure of the tansate/hydrochlorothiazide group decreased significantly (P<0.
    001), but there was no significant difference in blood pressure control between the groups (analysis of variance, P=0.
    39).

     Figure 2 Changes in systolic and diastolic blood pressure of patients during the OLAS study.
    The final systolic blood pressure of the Olmesartan medoxomil/amlodipine group and the Olmesartan medoxomil/hydrochlorothiazide group were 126.
    5±9.
    0 mmHg and 129.
    9±10.
    9 mmHg, respectively, and the final diastolic blood pressures were respectively 84.
    9±7.
    3 mmHg and 86.
    3±8.
    6 mmHg.

    Throughout the study, the average difference between the groups was 1.
    5 mmHg in systolic blood pressure and 0.
    8 mmHg in diastolic blood pressure.

     In the 26th week of the trial, 68.
    3% and 66.
    7% of the patients in the olmesartan medoxomil/amlodipine group and the olmesartan medoxomil/hydrochlorothiazide group respectively reached the target blood pressure before doxazosin treatment was added; at the end of the study At the time, they were 81.
    7% and 78.
    3%, respectively.

     Table 1 The final values ​​of basic parameters and metabolic parameters of patients in the two groups did not change significantly (week 78) The body mass index, waist circumference, fasting blood glucose, sodium, potassium, creatinine, blood lipids, bilirubin and transaminase of the two groups were checked at baseline There was no significant difference in time, and no difference between treatment groups was found throughout the study.

     At the same time, the albumin excretion rate of the two groups was significantly reduced (P<0.
    01), and there was no significant difference between the groups.

    In the olmesartan medoxomil/amlodipine group, the insulin resistance index (IRI) decreased by 24.
    1% (P<0.
    01), while adiponectin increased by 16.
    3% (P<0.
    01).

    The changes of IRI and adiponectin in the olmesartan medoxomil/hydrochlorothiazide group were not obvious.

     Among the inflammatory markers studied, the CRP of the two groups were significantly reduced, and there was no significant difference between the two groups.

    Other inflammation markers were only significantly reduced in the olmesartan medoxomil/amlodipine group (TNF-a decreased by 16.
    1%, IL-1b decreased by 18.
    5%, IL-6 decreased by 18.
    1%, IL-8 decreased by 12.
    8%, ICAM-1 Decrease by 20.
    8%, VCAM-1 decreased by 30.
    8%); all these inflammatory markers were significantly different between groups.

     During the study period, 3 patients (5.
    0%) in the olmesartan medoxomil/amlodipine group developed T2DM, and 11 patients (18.
    3%) in the olmesartan medoxomil/hydrochlorothiazide group (18.
    3%) in the olmesartan medoxomil/amlodipine group (olmesartan medoxomil/amlodipine group) The absolute risk is reduced by 13.
    3%).

     It is worth mentioning that the compliance of the two groups of patients is very high: at 26 weeks, the compliance rate of patients in the olmesartan medoxomil/amlodipine group was 96.
    1%, and at the end of the study was 92.
    7%; olmesartan medoxomil/hydrochlorothiazide The group was 94.
    1% and 91.
    8%, respectively.

     TIME Interactive Time Q: What do you think will be used for patients with hypertension and metabolic syndrome that will further aggravate their metabolic syndrome? Have you encountered such patients in your clinical work? What good experience and suggestions do you have regarding the choice of antihypertensive drugs for such patients? Olmesartan medoxomil/amlodipine can lower blood pressure while increasing compliance.
    It is an ideal choice for patients with metabolic syndrome.
    Han Lu Attending physician in the Department of Cardiology, Minhang District Central Hospital, Shanghai.
    With the improvement of material levels, people's lifestyles and diets Great changes have also taken place.
    The incidence of metabolic syndrome is getting higher and higher.
    However, patients with metabolic syndrome are often accompanied by hypertension, and we have encountered more and more such patients in the clinic.

    Therefore, blood pressure should be actively controlled for such patients, so that blood pressure should be controlled within 130/80 mmHg, which is beneficial to further reduce the incidence of cardiovascular events.

     In the choice of antihypertensive drugs, ARB/ACEI is preferred, CCB can also be used, and ARB/ACEI+CCB is preferred when combined medication is required.

    At present, there are also many single-tablet fixed compound preparations of ARB/ACEI+CCB in clinical practice, such as olmesartan medoxomil/amlodipine tablets and other drugs, which can better manage the blood pressure of patients, and the tolerance and compliance of patients are also Better, it can help patients.

    For patients with metabolic syndrome, antihypertensive drugs with insulin sensitization are the preferred choice.
    Liu Linlin, Chief Physician, Department of Nephrology, First Affiliated Hospital of China Medical University.
    Metabolic syndrome refers to the pathology of metabolic disorders in the body’s protein, fat, carbohydrates and other substances.
    State is a complex of metabolic disorders syndrome.

    The central link is obesity and insulin resistance.

    As stated in the literature, the rate of hypertension combined with metabolic syndrome can reach 50%, so the choice of antihypertensive drugs for such patients is crucial.

     Renin-angiotensin-aldosterone system inhibitor (RASI) has insulin sensitization effect, while CCB has no clear effect on insulin sensitivity.
    Thiazide diuretics and β-blockers can cause insulin resistance or even increase Risk of new-onset diabetes.

    Therefore, for patients with hypertension and metabolic syndrome, it is more beneficial to choose RASI with insulin sensitization, especially for blood sugar control and prevention of diabetes.

    For patients with hypertension and metabolic syndrome, individualized blood pressure management is the key Ruan Xiaofen, chief physician of the Department of Cardiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine.
    For patients with hypertension and metabolic syndrome, the use of thiazide diuretics will further aggravate their metabolic syndrome .

    Such patients are more common in the clinic.
    As for the choice of antihypertensive drugs for such patients, it is generally recommended to use ARB/ACEI-based antihypertensive treatment programs.

    "Chinese Hypertension Guidelines 2018 Revised Edition" pointed out: For patients with hypertension and metabolic syndrome, antihypertensive drugs mainly recommend ARB or ACEI, dihydropyridine CCB and potassium-sparing diuretics can also be used, and β-receptor blockers should be used with caution.
    Delays and thiazide diuretics.

    And many studies have confirmed that ACEI/ARB can improve insulin resistance.

     Finally, I believe that the choice of antihypertensive drugs for patients with hypertension and metabolic syndrome is a topic worthy of attention in our clinic.
    In practice, individualized blood pressure management must be emphasized.

    Sharing of clinical application experience Wang Rui, the attending physician of the Department of Cardiology, Putuo District Central Hospital, for hypertensive patients with metabolic syndrome, antihypertensive therapy is indispensable.
    Antihypertensive therapy has clear long-term benefits for cardiovascular and cerebrovascular diseases.
    For patients with metabolic syndrome, it continues , Stable pressure reduction is critical.

    Lu Jingping, Attending Physician of Department of Cardiology, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Olmesartan medoxomil/amlodipine has a strong effect on lowering blood pressure, with better efficacy and compliance.
    Olmesartan medoxomil combined with amlodipine can fully lower blood pressure and prolong the half-life.
    The patient's curative effect is better, and the compliance is higher.

    Wang Shi, deputy chief physician of the Department of Cardiology, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Olmesartan medoxomil/amlodipine has fewer side effects and more convenient dosage adjustment.
    Olmesartan medoxomil/amlodipine 1-2 tablets per day is convenient to use, and the combination of strong and strong blood pressure is stable, Faster and more helpful for patient blood pressure control.

    References: [1] Martinez-Martin FJ, Rodriguez-Rosas H, Peiro-Martinez I, et al.
    Olmesartan/amlodipine vs olmesartan/hydrochlorothiazide in hypertensive patients with metabolic syndrome: the OLAS study[J].
    Journal of human hypertension, 2011, 25(6): 346-353.
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