Evaluating the effectiveness and safety of high-dose rosuvastatin combined with telmisartan or amlodipine on glucose metabolism in hypertensive patients with impaired fasting glucose.

This study evaluated the effectiveness and safety of high-dose rosuvastatin (Crestor) combined with telmisartan (Micardis) or amlodipine (Norvasc) on glucose metabolism in patients with atherosclerotic cardiovascular disease (ASCVD), hypertension (high blood pressure), and impaired fasting glucose (IFG or prediabetes). The data showed that telmisartan significantly reduced the fasting glucose levels to normal glucose levels and prevented the new onset of diabetes in these patients.

Hypertension or high blood pressure (BP) is a common condition. It increases the risk of cardiovascular disease (CVD). Atherosclerotic CVD (ASCVD) is caused by blockages in the arteries due to high cholesterol. Managing BP and blood glucose is important to prevent the development of ASCVD.

Many medications, such as beta-blockers, angiotensin modulators, and statins, can reduce the risk of CVD events in people with ASCVD. Telmisartan is a drug that blocks the angiotensin II receptor. Amlodipine is a drug that blocks calcium channels. Rosuvastatin is a drug that treats high cholesterol. It is important to evaluate whether combining high-dose rosuvastatin with either telmisartan or amlodipine would have a positive effect on glucose metabolism in patients with ASCVD, IFG, and hypertension.

This study involved 99 patients with hypertension, ASCVD, and IFG. Patients were randomly assigned into 2 groups. Group 1 included 48 patients who received telmisartan plus high-dose rosuvastatin. Group 2 included 51 patients who received amlodipine plus high-dose rosuvastatin. Insulin resistance is the first step towards the development of type 2 diabetes (T2D). The study used homeostatic model assessment for insulin resistance (HOMA-IR). This model estimates how well cells respond to insulin, and it is based on fasting insulin and glucose levels. A low score means that a patient's cells are sensitive to insulin.

After 24 weeks, the HOMA-IR score was 2.4 in group 1 versus 2.7 in group 2. From the start of treatment to 24 weeks, the HOMA-IR score decreased by 7 in group 1 compared to 5.5 in group 2. These differences were not statistically significant.

Fasting glucose levels were significantly lower in group 1 compared to group 2 (107.7 mg/dL versus 113.3 mg/dL). From the start of treatment to 24 weeks, the fasting glucose level significantly decreased by 3.2% in group 1 compared to 3.8% in group 2.

After 24 weeks, the proportion of patients with fasting glucose levels of 100mg/dL or higher was significantly lower in group 1 than in group 2 (71.1% versus 89.6%).

After 24 weeks, the proportion of patients with new onset of diabetes was significantly lower in group 1 than in group 2 (12.5% versus 31.4%).

This study concluded that telmisartan did not decrease insulin resistance compared to amlodipine in ASCVD patients with IFG and hypertension. However, telmisartan significantly reduced the fasting glucose levels to normal glucose levels and prevented the new onset of diabetes in these patients.

This study did not include a control group. The follow-up time was too short to evaluate the change in insulin resistance. Both the patients and the investigators knew which treatment was given, which might affect the conclusions.