Pioglitazone Lowers BP, Improves Lipids in Patients with Type 2 Diabetes

Internal Medicine World ReportAugust 2005

Pioglitazone Lowers BP, Improves Lipids in Patients with Type 2 Diabetes

Orlando—The insulin sensitizing agent pioglitazone (Actos) reduces blood pressure (BP) in patients with type 2 diabetes and has beneficial effects on lipid abnormalities that occur in patients with diabetes and/or metabolic syndrome, said presenters at the American Diabetes Association meeting.

In a study of 3140 patients with type 2 diabetes and hypertension, all patients received open-label pioglitazone, 30 mg/day, for 2 weeks. Hypertension was classified as stage I or stage II according to current National Institutes of Health criteria (JNC 7), under which stage I is defined as 140 to 159/90 to 99 mm Hg and stage II is defined as ≥160/≥100 mm Hg.

Pioglitazone lowered BP by a mean of 6.9/3.1 mm Hg from baseline in patients with stage I hypertension, and by18.7/8.3 mm Hg in patients with stage II hypertension.

“Hypertension is frequently diagnosed in patients with type 2 diabetes and is often present years before disease onset,” said lead investigator Thomas Konrad, MD, of the Institute for Metabolic Research, Frankfurt, Germany. “In these patients, controlling hypertension is as important in controlling the glycemic level. These blood pressure-lowering findings are remarkable because they suggest that pioglitazone may be able to impact certain cardiovascular disease risk factors in patients with type 2 diabetes.”

Pioglitazone is thought to reduce BP by decreasing vascular resistance through an improvement in endothelial function, Dr Konrad added.

Other clinical studies presented at the meeting showed that pioglitazone has favorable effects on the dyslipidemia that occurs commonly with diabetes or metabolic syndrome. Investigators assessed 2444 patients with type 2 diabetes who were enrolled in 1 of 2 prospective, randomized, double-blind, multicenter, multinational trials in which the patients were randomized to receive pioglitazone, a sulfonylurea, or metformin (Glucophage) for as long as 52 weeks. The effects of the 3 treatments on components of diabetic dyslipidemia were analyzed.

High-density lipoprotein cholesterol (HDL-C) increased by 19.7% in patients assigned to pioglitazone, compared with a 10.5% increase among those assigned to metformin (P < .001) and 7.4% among those assigned to a sulfonylurea (P <.001). Pioglitazone was also significantly superior to the other 2 treatment groups in decreasing triglycerides (—10.4%, –0.6%, and –4.0% with pioglitazone, metformin, sulfonylurea, respectively) and the ratio of total to HDL-C (–9.8%, –7.7%, –9.0%, respectively).

In another study of 1269 patients with type 2 diabetes, pioglitazone and metformin were evaluated when added to existing sulfonylurea therapy; pioglitazone and sulfonylurea were also evaluated when added to existing metformin therapy. The investigators found that pioglitazone added to the sulfonylurea resulted in a 17% decrease in triglycerides compared with a 9% decrease when metformin was added to the sulfonylurea (P = .001). Pioglitazone added to metformin was associated with a 23% decrease in triglycerides compared with a 7% increase when sulfonylurea was added to metformin (P = .001).

In this same study, pioglitazone added to sulfonylurea also improved HDL-C by 21% whereas metformin addition was associated with a 15% increase (P = .001). When pioglitazone was added to metformin, HDL-C improved by 22%; sulfonylurea added to metformin increased HDL-C only an additional 7% (P = .001).

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