Vascular and Metabolic Effects of Combined Therapy With Ramipril and Simvastatin in Patients With Type 2 Diabetes

• Published in: Hypertension (Dallas, Tex. 1979) Tex. 1979), 2005-06, Vol.45 (6), p.1088-1093
• Main Authors: Koh, Kwang Kon, Quon, Michael J, Han, Seung Hwan, Ahn, Jeong Yeal, Jin, Dong Kyu, Kim, Hyung Sik, Kim, Dae Sung, Shin, Eak Kyun
• Format: Article
• Language: English
• Subjects: Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive agents; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - drug effects; C-Reactive Protein - metabolism; Cardiology. Vascular system; Cardiovascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Cross-Over Studies; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - physiopathology; Double-Blind Method; Drug Therapy, Combination; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Insulin Resistance; Lipids - blood; Malondialdehyde - blood; Medical sciences; Pharmacology. Drug treatments; Ramipril - therapeutic use; Simvastatin - therapeutic use; Vasodilation - drug effects
• ISSN: 0194-911X; 1524-4563
• DOI: 10.1161/01.HYP.0000166722.91714.ba

Mechanisms underlying biological effects of statin and angiotensin-converting enzyme inhibitor therapies differ. Therefore, we compared vascular and metabolic responses to these therapies either alone or in combination in patients with type 2 diabetes. This was a randomized, double-blind, placebo-controlled crossover trial with 3 treatment arms (each 2 months) and 2 washout periods (each 2 months). Fifty patients with type 2 diabetes were given simvastatin 20 mg and placebo, simvastatin 20 mg and ramipril 10 mg, or ramipril 10 mg and placebo daily during each 2-month treatment period. Ramipril alone or combined therapy significantly reduced blood pressure when compared with simvastatin alone. When compared with ramipril alone, simvastatin alone or combined therapy significantly improved the lipoprotein profile. All 3 treatment arms significantly improved flow-mediated dilator response to hyperemia and reduced plasma levels of malondialdehyde relative to baseline measurements. However, these parameters were changed to a greater extent with combined therapy when compared with simvastatin or ramipril alone (P