Efficacy and tolerability of slow release urapidil (ebrantil) in hypertensive patients with non-insulin dependent diabetes mellitus (NIDDM)

Urapidil, a new α-blocker that peripherally antagonizes postsynaptic α₁ receptors and centrally causes a reduction in sympathetic tone as agonist of the serotoninergic receptors, was assessed for its antihypertensive effect and its role on glucose and lipid metabolism and insulin sensitivity in diabetic hypertensive patients. Thirty-three non-insulin dependent diabetes mellitus (NIDDM) patients with diastolic blood pressure (BP) of 95-115 mm Hg were treated with either 30 or 60 mg urapidil twice a day, with a gradual increment up to a maximum of 90 mg b.i.d., in order to reduce diastolic pressure to < 90 mm Hg or by at least 10% in the sitting position. A significant reduction in systolic and diastolic arterial pressure, not accompanied by an increased heart rate, was achieved after 12 weeks of treatment. Lipid and carbohydrate homeostasis and glycemic control, as assessed by HbA₁C levels, were not affected. The fasting insulin concentration before the glucose load remained similar, but there was a trend toward reduction in peak insulin concentration, and the ratio of insulin change to glucose change between fasting levels and peak levels was significantly lowered by treatment, suggesting improved insulin sensitivity. In conclusion, urapidil is an effective antihypertensive agent in NIDDM patients with essential hypertension, with a neutral effect on lipids and carbohydrates and a possible beneficial effect on insulin resistance.