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Medical Department I, J. W. Goethe University (S.F., F.S., E.H., H.R., K.B., K.-H.U.), Frankfurt, Germany; Institute for Metabolic Research (T.K.), Frankfurt, Germany; and Takeda Pharma (G.L.), Aachen, Germany
Address correspondence to: Thomas Konrad, M.D., Institut für Stoffwechselforschung, European RISC Study Centre, Heidelbergerstrasse 13, D-60327 Frankfurt, Germany.
Abstract
Hypertension is often associated with insulin resistance, dyslipidemia and obesity, which indicate a prediabetic state and increased risk of cardiovascular disease. Pioglitazone treatment of patients with type 2 diabetes reduces insulin resistance and improves lipid profiles. The present double-blind placebo-controlled study is the first study to report effects of pioglitazone in non-diabetic patients with arterial hypertension. Following a one week run-in, 60 patients were randomized to receive either pioglitazone (45 mg/day) or placebo for 16 weeks. Insulin sensitivity (M-value) increased by 1.2 ± 1.7 mg/min/kg with pioglitazone compared with 0.4 ± 1.4 mg/min/kg (P = 0.022) with placebo. HOMA index was decreased (-22.5 ± 45.8) by pioglitazone but not by placebo (+0.8 ± 26.5; P < 0.001). Decreases in fasting insulin and glucose were significantly (P = 0.002 and P = 0.004, respectively) greater with pioglitazone than placebo. Body weight did not change significantly with either treatment. HDL-cholesterol was increased and apolipoprotein B was decreased to a significantly greater extent with pioglitazone. There was a significantly (P = 0.016) greater decrease from baseline in diastolic blood pressure with pioglitazone. These changes would suggest improved glucose metabolism and a possible reduction in risk of cardiovascular disease with pioglitazone treatment of non-diabetic patients with arterial hypertension.
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