Moxonidine should be considered a possible addition to therapy in hypertensive diabetic patients who are not controlled on ACE- inhibitors.
According to study, further pharmacological options are required to address the burgeoning cardiovascular disease epidemic, to which diabetes and the metabolic syndrome are contributing. Although clinical trials have been able to show improvements for patients on lifestyle intervention programs, in clinical practice the results with exercise or dietary therapies are often disappointing.
ACE-inhibitors should be considered the first choice therapy; but if you still can’t control your patients, then moxonidine, arguably, should become an option.
Moxonidine is a potent antihypertensive with a high selectivity for imidazoline receptors. Unlike most other antihypertensives it also has a positive effect on insulin resistance.
Hypertension and cardiovascular disease are such a problem in diabetics because insulin resistance doubles the risk of a cardiovascular event. Studies have shown that the risk of cardiovascular disease rises proportionally with increasing insulin resistance.
Insulin resistance is not only a problem in overweight patients but also in older patients, particularly post-menopausal women… certainly don’t want to use an antihypertensive that increases insulin resistance.
Beta-blockers have been shown to increase the risk of impaired glucose tolerance in patients with normal baseline glucose tolerance.
Of particular interest is the fact that although other hypertensive agents, such as beta-blockers, may lead to increases in body weight, moxonidine therapy appears to attenuate weight gain.
The MARRIAGE study (Moxonidine And Ramipril Regarding
Insulin And Glucose Evaluation) is currently comparing the effects of moxonidine and ramipril on blood pressure and glycemic control in overweight patients with mild to moderate hypertension and impaired fasting glycemia.