"Since high levels of hsCRP are a measure of cardiovascular disease, a reduction in this vasoactive inflammatory marker indicates a positive effect of valsartan use in this patient population," said Willa Hsueh, MD, chief, division of endocrinology, diabetes, and hypertension, UCLA School of Medicine, Los Angeles, California, United States.

Her team evaluated various markers of inflammation in 566 prediabetic patients with abdominal obesity in response to treatment with valsartan 320 mg/d, compared to hydrochlorothiazide 25 mg/d, or a combination of the two agents for 16 weeks.

"It has become increasingly apparent that the metabolic syndrome is also associated with vascular inflammation, and this may be one factor influencing the development of diabetes in some patients," Dr. Hsueh said in her poster presentation. "The choice of antihypertensive therapy is an important determinant of whether their metabolic status in patients susceptible to developing diabetes becomes improved or worsened."

Biomarkers of inflammation such as median hsCRP could be an effective measure to provide a better method of identifying high-risk individuals susceptible to developing diabetes, she added.

In diabetic patients with abdominal obesity, after 16 weeks of hydrochlorothiazide therapy, median hsCRP values were increased 16% (4.9 vs 3.7 mg/L at baseline, P <.05) but decreased 9% in patients on valsartan (3.7 vs 4.1 mg/L at baseline, P <.05) and 5% in patients on combination therapy. Also, the changes in hsCRP were only evident in patients with elevated levels (greater than 3 mg/L).

At the end of treatment, there were no changes in any of several biomarkers measured except for aldosterone and adinopectin. The investigators documented a significant decrease in plasma adinopectin levels versus baseline in the group treated with hydrochlorothiazide monotherapy. Plasma adinopectin levels were unchanged in the other two treatment groups.

Dr. Hsueh said that the study demonstrates that valsartan decreases hsCRP levels in prediabetic patients with metabolic syndrome and emphasized that additional research is needed to clarify why the thiazide diuretic and angiotensin receptor blocker have opposite effects on this vasoactive inflammatory marker in the study population.

Presented at the 22nd Annual Meeting of the American Society of Hypertension (ASH).
 [Presentation Title: Inflammatory and Metabolic Markers in Pre-Diabetic Patients with the Metabolic Syndrome: Influence of Antihypertensive Therapy. Abstract Number P-317]

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FACT:

Treatment of elderly patients with type 1 and type 2 diabetes in U.S. nursing homes often fails to meet American Diabetes Association standards, according to a new study.  Researchers at the Ohio University College of Osteopathic Medicine studied the quality of care received over a year by 108 diabetic residents living in 11 nursing homes. They found that only 38 percent of patients met blood glucose [sugar] goals, only 55 percent had satisfactory blood pressure levels, and only 31 percent had lipids (serum total cholesterol) checks yearly. Of those who had regular lipids checks, only 58 percent had acceptable levels.  See this week’s Item #9