Effects of combination therapy with an angiotensin converting enzyme inhibitor and thiazide diuretic on insulin action in essential hypertension

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Abstract
To determine whether combination of an angiotensin converting enzyme inhibitor with a high dose of thiazide diuretic avoids adverse metabolic consequences of thiazide diuretics. Double-blind randomized crossover study of two 12-week treatment periods with captopril (up to 100 mg/day) either alone or in combination with 5 mg bendrofluazide given after a 6-week placebo run-in period. Treatment periods were separated by a 6-week placebo washout period. Outpatient clinics in greater Belfast. Fifteen white non-diabetic essential hypertensives (seven male) aged Systolic and diastolic blood pressures and peripheral and hepatic insulin action. Two patients failed to complete the study. Blood pressure was lowered (139/89 ± 18/7 mmHg combination versus 160/97 ± 21/7 mmHg captopril; P P Combination therapy increased glucose production (compared with captopril alone), indicating hepatic insulin resistance. It cannot be assumed that combined preparations with angiotensin converting enzyme inhibitors will ameliorate adverse effects of high doses of thiazide diuretics on insulin action.