Trandolapril Does Not Improve Insulin Sensitivity in Patients with Hypertension and Type 2 Diabetes: A Double-Blind, Placebo-Controlled Crossover Trial

Angiotensin-converting enzyme (ACE) inhibitors are increasingly used as first-line therapy for hypertension in type 2 diabetes mellitus and are widely believed to improve insulin sensitivity (M). However, the evidence for the latter effect does not stand close scrutiny. We have assessed the effect of the ACE inhibitor trandolapril on M in 16 patients (mean ± sd age, 58 ± 10.6 yr) with mild-to-moderate essential hypertension (initial blood pressure, 173 ± 14.5/93 ± 8.0 mm Hg), obesity (body mass index, 30 ± 5.4 kg/m2), and impaired glucose intolerance (n = 4) or type 2 diabetes (n = 12) in a double-blind, placebo-controlled crossover design. All patients underwent three 3-h euglycemic hyperinsulinemic clamp studies (soluble insulin, 1.5 mU/kg·min) after a 2-week placebo run-in and at the end of two 4-week periods of treatment with 2 mg trandolapril or placebo (2-week washout). M (mean ± sd) did not change with trandolapril: placebo (run-in), 5.2 ± 1.98 mg/kg·min; placebo, 5.3 ± 1.70 mg/kg·min; trandolapril...