Aldosterone antagonism improves endothelial function (and reduces deaths) in chronic heart failure. It is not known whether similar effects occur in other high-risk groups such as patients with diabetes and hypertension. We therefore assessed the full effects of aldosterone blockade in poorly controlled hypertensive patients with type 2 diabetes, focussing on blood pressure, endothelial function, glycaemic control and key hormones. Spironolactone is highly effective in lowering blood pressure in patients with type 2 diabetes and poorly controlled hypertension on standard treatment, but does not improve vascular endothelial function in this group. We speculate that any tendency for the spironolactone-induced lowering of blood pressure to improve endothelial function is offset by its tendency to worsen glycaemic control and increase the levels of angiotensin II and even possibly cortisol.
Authors: K Swaminathan, J Davies, J George, N S Rajendra, A D Morris, A D Struthers
Keywords: aldosterone, blood glucose, diabetes mellitus type 2, diabetic angiopathies, endothelium, natriuretic peptide
DOI Number: 10.1007/s00125-008-0972-5 Publication Year: 2008
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