A randomized, double-blind clinical trial of canrenone vs hydrochlorothiazide in addition to angiotensin II receptor blockers in hypertensive type 2 diabetic patients

Abstract

AimThe aim of this study was to evaluate the effects of canrenone compared to hydrochlorothiazide (HCTZ) added to angiotensin II receptor blockers (ARBs) on glycemia, lipid profile, potassium, aldosterone and renal function in patients with hypertension and type 2 diabetes mellitus.Patients and methodsThe study enrolled 182 Caucasian patients with hypertension and type 2 diabetes mellitus. Patients were already taking ARBs and were randomized to canrenone, 50 mg once a day, or HCTZ, 12.5 mg once a day for 1 month. After the first month, patients not reaching an adequate blood pressure (BP) were up-titrated to canrenone 100 mg or HCTZ 25 mg once a day for 12 months. The following parameters were considered at 6 and 12 months: BP, body weight, body mass index (BMI), fasting plasma glucose (FPG), post-prandial glucose (PPG), fasting plasma insulin (FPI), homeostasis model assessment insulin (HOMA-IR), lipid profile, potassium, plasma aldosterone, urine albumin excretion rate and estimated glomerular filtration rate (eGFR).ResultsWe observed a similar decrease in BP with both treatments. Canrenone led to a significant decrease in FPG, PPG and HOMA index compared to baseline, while there was a significant increase in the same parameters with HCTZ. HCTZ also worsened glycated hemoglobin (HbA1c), while canrenone did not change it. No variations in lipid profile were recorded with canrenone, while there was a worsening of total cholesterol (TC) and triglycerides (Tg) with HCTZ. Potassium levels were decreased and uric acid levels were increased by HCTZ, but not by canrenone that had a neutral effect on these parameters. We recorded a slight decrease in eGFR with HCTZ and an improvement with canrenone; creatinine and eGFR were improved by canrenone compared to HCTZ. Plasma aldosterone levels were decreased by canrenone and increased by HCTZ.ConclusionCanrenone and HCTZ have a similar effect on BP; however, canrenone seems to improve metabolic parameters, while HCTZ worsens them.

Temporal Associations Among Body Mass Index, Fasting Insulin, and Systemic Inflammation

“…Of these, 753 articles were excluded, resulting in 60 that met the selection criteria and 5603 enrolled participants (of whom 5261 were analyzed). 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 ...…”

“…A total of 90% of the studies were in populations with metabolic disease or conditions associated with metabolic disease: obesity, 25 , 32 , 33 , 34 , 37 , 41 , 43 , 45 , 47 , 48 , 49 , 52 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 76 , 77 , 79 , 80 , 81 , 82 , 83 diabetes or prediabetes, 26 , 32 , 38 , 46 , 59 hypertension, 40 coronary artery disease, 65 dyslipidemia, 51 chronic kidney disease, 78 nonalcoholic fatty liver disease, 31 , 35 Cushing disease, 36 polycystic ovary syndrome, 61 breast cancer, 28 , 56 , 82 and aging (ie, college students 84 ). Of the patients in these 54 studies, 22 (41%) had undergone bariatric surgery as the studied intervention (n = 14) or as part of the required eligibility criteria (n = 8).…”

“…After the initial screening, the full texts of 813 articles were retrieved for detailed evaluation. Of these, 753 articles were excluded, resulting in 60 that met the selection criteria and 5603 enrolled participants (of whom 5261 were analyzed) . We decided to exclude 12 studies of children and adolescents post hoc because these studies used different BMI measures.…”

“…A total of 21 studies were from Western Europe, 25,27,41,54,61,62,65,72,81,82,84 11 from North America, 25,27,41,54,61,62,65,72,81,82,84 9 from East Asia, 29,38,39,44,51,52,60,66,68 5 from South America, 28,69,78,79,83 5 from Western Asia, 28,69,78,79,83 and 3 each from Africa, 35,50,76 the Pacific, 26,42,75 and Eastern Europe. 45,74,80 A total of 90% of the studies were in populations with metabolic disease or conditions associated with metabolic disease: obesity, 25,32-34,37,41,43,45,47-49,52,57-60,62-64,67-74,76,77,79-83 diabetes or prediabetes, 26,32,38,46,59 hypertension, 40 coronary artery disease, 65 dyslipidemia,...…”

<p>Letter regarding the article, &ldquo;A randomized, double-blind clinical trial of canrenone vs hydrochlorothiazide in addition to angiotensin II receptor blockers in hypertensive type 2 diabetic patients&rdquo;</p>

“…Previous studies have confirmed the utility of canrenone to control inflammation, microalbuminuria, and cardiovascular risk 1,2. Recently, we read with great interest the study by Derosa et al3 The authors performed a randomized, double-blind clinical trial to compare the effectiveness of canrenone vs hydrochlorothiazide (HCTZ) in addition to angiotensin II receptor blockers (ARBs) in patients with hypertension and type 2 diabetes mellitus. The primary endpoints were blood pressure, glycemia, lipid profile, potassium, aldosterone, and renal function.…”