Nitric oxide metabolism and insulin resistance in patients with essential hypertension with signs of left ventricular remodeling under the influence of antihypertensive drug therapy
The aim of study was to determine the blood level of NO metabolites and insulin resistance index (IR), their relation to the structural-functional parameters of the left ventricle in patients with essential hypertension (EH) with signs of left ventricular remodeling under therapy with enalapril and losartan; to conduct the comparative analysis of influence of treatment these drugs on the above-mentioned indexes. 40 patients (25 men and 15 women) with mild and moderate EH were examined, mean age 53.63±5.58 years, anamnesis of EH – 7.67±2.5 years. The body mass index (BMI) averaged 30.11±3.38 kg/m2. Рatients received losartan (50–100 mg daily), n=21, or enalapril (10–40 mg daily), n=19. Baseline and after 24 weeks of treatment patients underwent clinical investigation, 24-hour blood pressure monitoring, Doppler echocardiography, duplex scanning of carotid arteries with determination of intima-media thickness (IMT). Brachial artery diameter during reactive hyperemia was used to test endothelium-dependent vasodilatation (EDVD) аccording to D.S. Celermajer. The examination also included the determination of NO stable metabolites, insulin levels in the blood serum, glucose, total cholesterol, triglycerides (TG). Insulin resistance (IR) was estimated with the use of НОМА-IR criterion. Long-term therapy with enalapril or losartan in patients with EH at equivalent effective control of BP was accompanied by the improvement of EDVD and limitation of NO hyperproducts at equal degree. Left ventricular hypertrophy and diastolic dysfunction diminished more under the influence of losartan. Under long-term treatment with enalapril and losartan, positive changes of insulin resistance were noted, more expressed for losartan: after 24 weeks of therapy level of HOMA-IR decreased by 33 % (Р=0.004).