Effect of Renin-Angiotensin system blockade on insulin resistance and inflammatory parameters in patients with impaired glucose tolerance.

Objective: The study investigated the effect of angiotensin receptor blockers (ARB) on glucose homeostasis and inflammatory parameters in patients with impaired glucose tolerance (IGT).

Methods: We prospectively studied the insulin sensitivity index (ISI) and homeostasis model assessment-insulin resistance (HOMA-IR) in 13 obese males with IGT and in 13 matched control subjects with normal glucose tolerance (NGT) during hyperglycemic testing over 90 min. Adiponectin, retinol-binding protein 4 (RBP4), and high-sensitive C-reactive protein (hsCRP) were analyzed. Measurements were performed at baseline and after a 4-week treatment with 160 mg/day valsartan. The results of the IGT and NGT groups were compared.

Results: At baseline, HOMA-IR (IGT 4.1 +/- 3 vs. NGT 2.3 +/- 1.0, P < 0.01), hsCRP (IGT 3.9 +/- 1.9 vs. NGT 1.8 +/- 1 mg/l, P < 0.05), and RBP4 (IGT 27.1 +/- 2.1 vs. NGT 24.0 +/- 2.0 ng/ml, P < 0.05) were significantly higher, whereas ISI (IGT 1.5 +/- 0.9 vs. NGT 1.8 +/- 1.2, P < 0.05) and plasma adiponectin (IGT 3.2 +/- 0.9, NGT 5.2 +/- 2.4 microg/ml, P < 0.05) were significantly lower in the IGT group compared with the NGT group. Under ARB, there was an increase in both groups of adiponectin (IGT 4.1 +/- 1.9 microg/ml, NGT 6.3 +/- 2.9 microg/ml, P < 0.05) and an increase in ISI (IGT 1.5 +/- 0.9 to 2.3 +/- 1 microg/ml, NGT 1.8 +/- 1 to 2.5 +/- 2 microg/ml, P < 0.05). HOMA-IR (4.1 +/- 3 to 2.6 +/- 2; P < 0.01), hsCRP (3.9 +/- 1.9 to 1.8 +/- 1 mg/l, P < 0.05), and RBP4 (27.1 +/- 2.1 to 22.1 +/- 1.8 ng/ml, P < 0.01) decreased significantly in the IGT group.

Conclusions: Insulin sensitivity and associated inflammatory factors improve under ARB in IGT patients.