Public Health Insights into Cardiovascular Risks among Diabetic Patients: Evaluating the Individual and Combined Effects of Amlodipine and Metformin

James Watt; Zahidullah; Ali Raza Sandhu; Misbah Zakir Abowath; Aisha Alamgir

doi:10.70749/ijbr.v3i1.440

Authors

James Watt St. James Institute of Nursing and Health Sciences, Karachi, Sindh, Pakistan.
Zahidullah Saida Waheed FMH College of Nursing, Lahore, Punjab, Pakistan.
Ali Raza Sandhu Basic Health Unit-376 JB, Toba Tek Singh, Punjab, Pakistan.
Misbah Zakir Abowath Department of Dermatology, Institute of Skin Diseases, Karachi, Sindh, Pakistan.
Aisha Alamgir School of Public Health, Dow University of Health Sciences, Karachi, Sindh, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i1.440

Keywords:

Cardiovascular Disease, Diabetes Mellitus, Amlodipine, Metformin, Hypertension, Type 2 Diabetes Mellitus, Glycemic Control, Anxiety, Depression, Mental Health

Abstract

Background: Diabetes patients are more susceptible to cardiovascular disease (CVD), hence lowering the risk factors linked with CVD requires effective treatment techniques. Objective: To evaluate the individual and combined effects of Amlodipine and Metformin on cardiovascular risks in diabetic patients. Methodology: A prospective randomized, double-blind cohort study was conducted at three hospitals in Pakistan, enrolling 1,386 adults with type 2 diabetes over two years. Three groups of participants were randomly assigned to receive either amlodipine, metformin, or both. The dosages were modified in accordance with the clinical response, and blood pressure, glycemic control, and cardiovascular risk indicators were observed at regular intervals of 3, 6, 12, 18, and 24 months. SPSS version 26 was used to analyze the data. The three groups were compared for differences in cardiovascular risk using comparative analyses (t-tests). A significant threshold of p < 0.05 was established. Results: When it came to cardiovascular risk indicators, the Combination group outperformed the Amlodipine and Metformin groups by a substantial margin at 24 months. With statistically significant p-values (p=0.004, p=0.015), the decreases in systolic blood pressure (130.03 mmHg) were more marked than those in the Amlodipine (132.63 mmHg) and Metformin (132.13 mmHg) groups. Additionally, the Combination group had the lowest Hemoglobin A1c (HbA1c) values, 5.81 ± 0.51; this suggests better glycemic management. Moreover, significant enhancements in lipid profiles and decreases in fasting blood glucose levels were seen. Conclusion: The combination of Amlodipine and Metformin provides superior cardiovascular protection in diabetic patients, highlighting the importance of dual therapy in managing cardiovascular risks associated with diabetes.

Downloads

Download data is not yet available.

References

Balakumar, P., Maung-U, K., & Jagadeesh, G. (2016). Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacological Research, 113, 600-609. https://doi.org/10.1016/j.phrs.2016.09.040

Glovaci, D., Fan, W., & Wong, N. D. (2019). Epidemiology of diabetes mellitus and cardiovascular disease. Current Cardiology Reports, 21(4). https://doi.org/10.1007/s11886-019-1107-y

Jyotsna, F., Ahmed, A., Kumar, K., Kaur, P., Chaudhary, M. H., Kumar, S., Khan, E., Khanam, B., Shah, S. U., Varrassi, G., Khatri, M., Kumar, S., & Kakadiya, K. A. (2023). Exploring the complex connection between diabetes and cardiovascular disease: Analyzing approaches to mitigate cardiovascular risk in patients with diabetes. Cureus. https://doi.org/10.7759/cureus.43882

Amin, R., Ali, Y., Idrees, S., Bilal, A., Safeer, B., & Manzoor, A. (2024). The role of combination therapies in optimizing diabetes management. Indus Journal of Bioscience Research, 2(2), 582-588. https://doi.org/10.70749/ijbr.v2i02.244

Hossain, M. J., Al‐Mamun, M., & Islam, M. R. (2024). Diabetes mellitus, the fastest growing global public health concern: Early detection should be focused. Health Science Reports, 7(3). https://doi.org/10.1002/hsr2.2004

Zulfiqar, R., Abbas, K., Khan, S., Fatima, K., Manzoor, A., & Awais, M. (2024). Long-term benefits of continuous glucose monitoring combined with insulin pump therapy. Indus Journal of Bioscience Research, 2(2), 785-791. https://doi.org/10.70749/ijbr.v2i02.264

Hamid, H., Khan, I. A., Huma, S., Khan, M. N., Khan, M. I., Salman, M., Ali, Y., & Rahman, I. (2022). Frequency of cardiovascular problems in patients with benign prostate enlargement. Pakistan Journal of Medical and Health Sciences, 16(6), 748-750. https://doi.org/10.53350/pjmhs22166748

Balakumar, P., Maung-U, K., & Jagadeesh, G. (2016). Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacological Research, 113, 600-609. https://doi.org/10.1016/j.phrs.2016.09.040

Elliott, W. J., & Ram, C. V. (2011). Calcium channel blockers. The Journal of Clinical Hypertension, 13(9), 687-689. https://doi.org/10.1111/j.1751-7176.2011.00513.x

Cole, J. B., Lee, S. C., Prekker, M. E., Kunzler, N. M., Considine, K. A., Driver, B. E., Puskarich, M. A., & Olives, T. D. (2022). Vasodilation in patients with calcium channel blocker poisoning treated with high-dose insulin: A comparison of amlodipine versus non-dihydropyridines. Clinical Toxicology, 60(11), 1205-1213. https://doi.org/10.1080/15563650.2022.2131565

Marín-Peñalver, J. J., Martín-Timón, I., Sevillano-Collantes, C., & Cañizo-Gómez, F. J. (2016). Update on the treatment of type 2 diabetes mellitus. World Journal of Diabetes, 7(17), 354. https://doi.org/10.4239/wjd.v7.i17.354

De Jager, J., Kooy, A., Schalkwijk, C., Van der Kolk, J., Lehert, P., Bets, D., Wulffelé, M. G., Donker, A. J., & Stehouwer, C. D. (2013). Long‐term effects of metformin on endothelial function in type 2 diabetes: A randomized controlled trial. Journal of Internal Medicine, 275(1), 59-70. https://doi.org/10.1111/joim.12128

Ramirez, A. J., Sanchez, M. J., & Sanchez, R. A. (2019). Diabetic patients with essential hypertension treated with amlodipine. Journal of Hypertension, 37(3), 636-642. https://doi.org/10.1097/hjh.0000000000001907

He, H., Zhao, Z., Chen, J., Ni, Y., Zhong, J., Yan, Z., Li, Y., Liu, D., Pletcher, M. J., & Zhu, Z. (2012). Metformin-based treatment for obesity-related hypertension. Journal of Hypertension, 30(7), 1430-1439. https://doi.org/10.1097/hjh.0b013e328353e249

Kupsal, K., Mudigonda, S., NVBK, S., & Neelala, K. (2016). Metformin combinatorial therapy for type 2 diabetes mellitus. Journal of Metabolic Syndrome, 5(3). https://doi.org/10.4172/2167-0943.1000210

Weng, S., Luo, Y., Zhang, Z., Su, X., & Peng, D. (2020). Effects of metformin on blood lipid profiles in nondiabetic adults: A meta-analysis of randomized controlled trials. Endocrine, 67(2), 305-317. https://doi.org/10.1007/s12020-020-02190-y

Tanaka, M., Nishimura, R., Nishimura, T., Kawai, T., Meguro, S., Irie, J., Saisho, Y., & Itoh, H. (2014). Effect of single tablet of fixed-dose amlodipine and atorvastatin on blood pressure/lipid control, oxidative stress, and medication adherence in type 2 diabetic patients. Diabetology & Metabolic Syndrome, 6(1). https://doi.org/10.1186/1758-5996-6-56

Kadoglou, N. P., Kapelouzou, A., Tsanikidis, H., Vitta, I., Liapis, C., & Sailer, N. (2010). Effects of Rosiglitazone/Metformin fixed-dose combination therapy and metformin monotherapy on serum Vaspin, Adiponectin and IL-6 levels in drug-naïve patients with type 2 diabetes. Experimental and Clinical Endocrinology & Diabetes, 119(02), 63-68. https://doi.org/10.1055/s-0030-1265174