COMPARATIVE STUDY OF THE EFFECTS OF ANTIHYPERTENSIVE THERAPY ON THE GLYCEMIC PROFILE OF HYPERTENSIVE PATIENTS IN OUTPATIENT FOLLOW-UP

Abstract

Background: Antihypertensive treatment regimens may exert distinct metabolic effects, including changes in insulin sensitivity. Renin–angiotensin system (RAS)–modulating drugs, such as angiotensin-converting enzyme inhibitors (ACEIs), have been associated with a more favorable metabolic profile.

Objective: To compare the effects of three antihypertensive treatment regimens—ACEI monotherapy, ACEI combined with other antihypertensive agents, and combination therapy with non–RAS-modulating antihypertensives—on blood pressure control, renal function, and glycemic profile in hypertensive patients.

Methods: This cross-sectional study included 268 adults with arterial hypertension under regular treatment. Plasma glucose, insulin, urea, and creatinine levels were measured, as well as the microalbuminuria/creatininuria ratio. Insulin resistance was estimated using the HOMA-IR index. Differences between groups were assessed using the Tukey–Kramer test, with p<0.05 considered statistically significant.

Results: Blood pressure control and renal function were similar across groups. Patients receiving ACEI combined with other antihypertensive agents showed a significantly worse glycemic profile, with higher glucose, insulin, and HOMA-IR values compared with ACEI monotherapy and non–RAS antihypertensive combination therapy (p<0.001). Diuretics were the most frequently associated drugs with ACEIs.

Conclusion: The potential metabolic benefits of ACEIs on glycemic profile may be attenuated when these agents are combined, predominantly with diuretics, in hypertensive patients.