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Blockade of the renin-angiotensin system (RAS) increases adiponectin concentrations and improves insulin sensitivity in patients with essential hypertension.
The results from a number of recent trials "suggest that RAS blockade may substantially lower the risk for type 2 diabetes. One of the mechanisms underlying this effect may be an increase in adiponectin concentrations by RAS blockade," stated lead investigator Dr. Masato Furuhashi.
To investigate, Dr. Furuhashi and colleagues at Sapporo Medical University School of Medicine studied 12 essential hypertensive patients with insulin resistance, 18 without insulin resistance and 20 normotensive controls.
The hypertensives with insulin resistance had significantly higher levels of insulin and triglycerides and lower levels of adiponectin than those in the other two groups.
Furthermore, adiponectin levels were positively correlated with whole body insulin sensitivity (M value) as estimated by glucose clamp. This value was also an independent predictor of adiponectin concentration.
The researchers treated a total of 16 of the essential hypertensives for 2 weeks with the angiotensin-converting enzyme inhibitor temocapril (4 mg per day) or the angiotensin II receptor blocker candesartan (8 mg per day).
Both treatments significantly decreased blood pressure and increased the M value and adiponectin concentrations, but did not affect body mass index and HDL cholesterol.
"The demonstration that RAS blockade increases adiponectin concentrations with improvement in insulin sensitivity,"might provide a scientific rationale for the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers for the prevention of diabetes in high-risk hypertensive patients," concluded Dr. Furuhashi Hypertension 2003;42:76-81
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