Hitgh Blood Pressure on Tx

Whats up guys!! I'm 6 weeks into Tx now.. I'm still feeling pretty good.. No exteme Sx so far... I'm in the Telaprevir trial and i go to the study nurse almost every week to get the blood test and to get a quick physical.. well every time i go my blood pressure is threw the roof... 148/102 I went to my regular doc and she gave me a script for blood pressure meds... Do you think the Hep C Meds are causeing my high blood pressure???

i'm already taking 12 pills aday for the hep c, now i gotta take more pills.. Great
I know high blood pressure is a serious thing and i wanna know if i can get away with out taking the pressure meds??
Is there a different way to fix my blood pressure without taking the meds??? or should i shut up and just take the pills?? lol

I did have little problems before tx with blood pressure but it turn out that i was just extremely **** off about having Hep c... so when i relaxed alittle my blood pressure would go to normal...

If nobody knows i am UND at 2 weeks into Tx.. I'm responding well :0)

[Tippyclubb]

Great news about being UND and still feeling good.  

I don't know about the blood pressure but did you get the script your doc wrote okayed with your trial nurse?  Vertex provided me a list of meds not to take and there's a lot of them for high blood pressure on the list.  Just make sure they know what your taking.

At first my blood pressure was a little low and she told me the meds could do that but I don't know about it being high.  I'm sure some one will.

[BklynBoy81]

yup i talk to the trial nurse and she OK the blood pressure meds..

[portann]

To Tippy:

I'd be very grateful if you'd post the high blood pressure meds Vertex says not to take.

To BB:

I'm as frustrated as you about the connection between high blood pressure and tx.

There really isn't a lot of information out there and few people here seem to have this 'side effect'. Many people may not monitor their pressure and wouldn't be aware of fluctuations. Or it may simply be uncommon.

I went from normal blood pressure before tx to continually increased doses, still with no success.

Before tx, all my techniques to control pressure without meds worked well. On tx, nothing works (so far not even the meds).

I have very elevated diastolic (resting) pressure, like you. Yours is high, at 102, and that's what I'm running into, even on meds. (The current ideal is 115/75.) My problem is that the meds send my systolic plummeting to 100, making me feel faint, but so far are ineffective for my diastolic. Bummer. It's tricky for the doc to sort out.

As you said, high blood pressure is serious when left untreated. It insidiously and slowly does damage that can have fatal consequences.

Treating it, though, can be a pain in the arteries.

I'd recommend taking the pills. I hope this is only temporary for both of us. Which ones did your trial nurse approve?

And congratulations on your UND at TWO weeks. That's huge, wonderful news. Do you know how many weeks you'll be treating altogether?

[Tippyclubb]

Ok here is what it says:

Medications that should not be taken with Telaprevir because of potential for serious drug interaction.  

For high blood pressure:
bepridil, verapamil, diltiazem, felodipine, nifedipine, nisoldipine


There's plenty more on the list but only included the ones for high blood pressure.

[portann]

Thank you!

[BklynBoy81]

so you take blood pressure meds and they dont work.. that ***** what does the doc say..

the trial nurse approved atenolol

[apache1]

My bp pre tx was 110-115/75-80 resting heart rate 62-65
During tx bp  was 120-130/80-90 resting heart rate 80-95

During tx my bp and heart rate sometimes spiked very high for no determinable to me, reason.

Now, 7 weeks post eot, this morning my bp was 115/73, heart rate 66. This was the first time my # have been back to normal since I started TX.

Have also been doing moderate cardio exercise, and some weights again for last 5 weeks.

apache

[BklynBoy81]

Did you take any BP meds on Tx??

[Max60]

My BP varied during tx. I was 'excited' (as in having a ribatude) at the doc's office and it was 170 over high. I went in about week 20 (of 24) and it was 116 over very good. I did start lisinopril after finishing. It had been borderline high for several years. . .. not really tx related.

Of interest to me is managing my rising cholesterol post tx. I'm going with diet and exercise. It would be ironic to get rid of the virus just to have a stroke.

[apache1]

Nope, do not take, and never have taken any bp meds...or any other habitual meds. Other than peg and riba.

apache
  

[copyman]

As you know I'm in the same trial as you. I had boarderline high BP before TX and was on a low dose of meds before starting trial, 40mg micardis per day. I have been on the BP meds all through the trial and the nurse got approval from Vertex. Actually my BP has been low normal since being on TX. I'm hoping I can stop the BP meds after tx.

[portann]

Bingo! You're on a beta-blocker and I've been mulling over whether this is the ticket for tx.

I'm on Ramipril, an ace inhibitor that has such good reviews, it's mind-boggling. And it doesn't work for me for my tx-related pressure.

Beta-blockers fell out of favor and had bad press, even though my mom took it successfully for years. Somehow, it makes sense to me that how it dilates the arteries and slows down the heart would be a perfect match with the side effects of tx. My doc loves ace inhibitors but I think she may be missing something.

Copyman, who prescribed your betablocker, your MD or your hepatologist?

BB, you've been prescribed a beta-blocker also, so please let us know if you respond to it. I'm excited about this now, since I've been frustrated as h-ell taking medications that don't work when I typically take nothing at all, not even vitamins.

[BklynBoy81]

thank you guys for your comments.. I guess im gonna take the meds even if i dont wanna... If it helps my BP than so be it.. i just didnt want extra meds and more sx...  i hope i dont have to take these meds after Tx either... I really dont want any more toxins in me, so after tx im gonna try to be as healthy as possible... the doc put me on 25mg of atenolol i think its a low dose also.. a stoke at 27 years old is possible...
your right It would be ironic to get rid of the virus just to have a stroke...so more meds it is... hope they work... thanks guys

BkBoy

[portann]

Sorry, my bad. Micardis is an ARB. Someone who is on it recently told me it's a beta-blocker but I just looked it up.

Nice that it's working for you.

[CoWriter]

"Beta-blockers fell out of favor and had bad press, even though my mom took it successfully for years. Somehow, it makes sense to me that how it dilates the arteries and slows down the heart would be a perfect match with the side effects of tx. My doc loves ace inhibitors but I think she may be missing something."
-----------------------------

Actually, beta-blockers and diuretics increase a patient's risk of developing DIABETES. while ACE inhibitors and Angiotensin Receptor Blockers decrease the risk of diabetes. Clinical guidelines in Great Britain, (but not the US), call for avoiding diuretics and beta-blockers as first-line treatment of hypertension due to the risk of diabetes.

http://en.wikipedia.org/wiki/Beta_blocker


I certainly wouldn't want to try a beta blocker during treatment when developing IR/Diabetes can make you fail.

Do you know what Metformin, ACE inhibitors, and statins have in common?  They're anti-oxidants.  That's why all of them can prevent diabetes.    

This is one of my favorite articles. Yes, I have lots of favorites...LOL

"Is Oxidative Stress the Pathogenic Mechanism Underlying Insulin Resistance, Diabetes, and Cardiovascular Disease? The Common Soil Hypothesis Revisited"

http://atvb.ahajournals.org/cgi/content/full/24/5/816

Co

[jmjm530]

Yes, somewhat the opposite in the U.S. where diuretics have received recent press with study backing as the most effective first-line rx treatment for high bp. For example, my internist suggest hydrochlorothiazide to start with, that being a very common diuretic. On the other hand, my cardio likes the Ace Inhibitors to start. And to add to the confusion, my tx doc liked the combo treatments like Hyzzar which combine the angiotensin II receptor Losartan with the diruetic  hydrochlorothiazide.

All this left me one very confused guy  :) and lately I've been experimenting with both losartan and  hydrochlorothiazide either solo or in combination to see what actually works as no sense taking a combo like Hyzaar if one drug is simply going along for a free ride without benefit. I have yet to try an Ace Inhibitor but hear they have more side effects (dry throat and coughing for example) than an angiotensin II receptor like Cozaar.

Any more suggestions here would be welcome because while I'm confused, maybe if I get more confused I will then see some clarity.

-- Jim

[Rockerforlife]

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[portann]

Dear Co:

I hope BB has a chance to read your post and then discusses the betablocker with his doctor, who prescribed it to be taken during tx. There may be a valid reason for this class of drug during tx but the NP is likely unaware of the IR risk.  I'd love to hear back from BB about the doctor's reason. Maybe it's a balancing act. (Please don't laugh.)

I know beta-blockers are out of fashion, except under the table for performance anxiety, so thank you very much for sending me great information that confirms this. Still, it's important to say again that my mom took it successfully for at least thirty years. She didn't develop diabetes or have cardiac events.

Jim:

My ACE may be a beauty of a drug by all accounts but it ain't bringing down my isolated diastolic during tx. Nonetheless, I love what I read about the 'magic' ACE and don't mind taking it. I prefer it to an ARB, which hasn't been studied as long. There was some very bad press about it recently (I'm linkless today) in combination with ACE.  

I  briefly had a dry cough but nobody who's done tx would likely give it a second thought. It was tolerable and temporary.
  
Rocker:

I love avocados, always have, except for when I overdosed on them and couldn't bear to have them in sight. Avocados aren't enough, though, sorry to say.

[jmjm530]

I'd be interested in anything you have regarding problems with ARBs.

Regarding your ACE:

(1) What strength did you try and was it suggested to titrate up ?

(2) Any side effects

(3) Did it bring down your systolic and how much?

(4) Have you tried diuretics either with it, or alone? I've read a diuretic can amplify the effects of the ACE but maybe it's just additive.

Of course it your ACE isn't doing its job then you have to change, what will be your next drug of choice?
--------

[BklynBoy81]

the bad thing is i got the meds now i started last night and i did talk to my regular doc about my mom having diabetes and my grandmother had Hypoglycemia... Great now what do i do... i have the meds.. the study nurse said it was OK USA... like co writer said the hep c meds can cause diabetes.. But my blood pressure did go down, its normal on the meds i checked today...

what do u guys think i should do now??? i have enough BP meds for a month...

[jmjm530]

Just re-read your post and saw your systolic really plunged! That's what I need, something to lower my systolic as my distolic is OK.

[jmjm530]

Are you IR or diabetic? If not, I doubt that will happen on treatment regardless of what bp meds you take and I assume your blood will be monitored on a reg basis. Personlly, I'd go with whatever works at least during tx. My liver specialist suggested Hyzaar which contains a diuretic while I was treating and he is well versed in IR andp diabetes not to mention treatment! Do you monitor at home? This is important to distingiuish high bp from white coat syndrome. Also, I hve found that cutting down on salt helps as well as exercise but the latter can be difficult on tx. Lastly, sleep on your stomach or side versus your back. Kid you not, they studied this and it can lower bp

[portann]

I have to run but wow, BB, throw me some of your atenolol my way!  I'll take it for a day to see what happens.

Maybe you're just a dream responder but unless this was a random reading, I'm popping my eyes wide open to hear this. And you're also a dream responder on your trial, you lucky guy. Remember, I'm an old f-art, so I may be a tougher case to crack.

I'm totally confused and it looks like several of us are, so let's not allow confusion to raise our blood pressure. Someone will sort it out one way or the other. The situation isn't urgent.

Co?

Jim:

Sorry, Zombie has to run. I promise to reply tonight.

[BklynBoy81]

im not ir or diabetic.. but my mom is probably doesn't matter... white coat syndrome is what i thought i had but I did check at the supermarket before i got the drugs... i check when i get to the supermarket and i sit down there for like 10 mins and check again.. lol i have been sleeping on my stomach pretty much my whole life... i actually do good with the foods i choose to eat.. i dont eat much salt at all.. im thinking its the hep c meds that are causeing my High BP

[CoWriter]

So there you go Jim.  As per Rocker's suggestion, eat two avocados and call me in the morning....LOL

Co

[CoWriter]

"Are you IR or diabetic? If not, I doubt that will happen on treatment regardless of what bp meds you take"
-------------------------

Here we go again.....

He has a family history of diabetes, he's on a PI, which can cause IR, on interferon which can also cause IR,  he's just been put on a beta-blocker which can cause diabetes and he'll be on tx for months.  

That is tempting fate if you ask me.  


"and I assume your blood will be monitored on a reg basis. Personlly, I'd go with whatever works at least during tx."
-------------------

A 27 year old who suddently develops high blood pressure (which is part of the metabolic syndrome, BTW), has a family hx of diabetes, and is on a tx that can cause IR/diabetes....I would say he should have been checked for IR before handing him the Rx for a bp med...and I bet you they didn't do it (and I doubt his insulin level was checked pretreatment).

Putting a 27 year old with a family hx of diabetes on a medication that is well known for causing diabetes and which he may have to take for the rest of his life (because I doubt his bp will normalize after tx), is like inviting diabetes to come and get him.  And you think that doctor is going to "monitor him on a regular basis"?  Yeah, right!

Co

[BklynBoy81]

so what do u think i should do?? im on 25mg of atenolol and the doc told me to take it two times aday.. she said its a low dose but im not to sure if it is..

[CoWriter]

(see my post to Jim)

I would ask the doctor to change it.  If he asks why, I would say.....

1.  Because I have a family history of diabetes and beta blockers are known to cause diabetes.
2.  Because interferon can cause insulin resistance/diabetes.
3.  Because PI's can cause insulin resistance.
4.  Because insulin resistance and diabetes can lower SVR greatly.
5.  Because there are better options.

Co

[CoWriter]

But don't stop taking it until they replace it with something else.

Co

[BklynBoy81]

what are the better options when i cant take bepridil, verapamil, diltiazem, felodipine, nifedipine, nisoldipine.. and i already filled the prescription.. these drugs are BP meds that cant be takin with the PI.. Does anyone know of an Bp med that i would not have a problem with..

[jmjm530]

CO: Here we go again
--------------------------------

Has anyone told you that you see life through IR colored glasses LOL

I do think it's an important topic but that doesn't mean the shoe fits all, especially if someone RVRd. And speaking of IR and related,  the drugs used to control it are not without risks which seems rarely pointed out here.

Someone posted a few weeks ago that their doctor already has one patient who needed a transplant, the damage caused by one of the IR drugs. Let's use these drugs when needed, but not as a first line defense (let's try diet/weight loss and exercise first) or because we think that someone *may* develop IR on treatment when in fact they are not. OK, here we went again :)

-- Jim

[CoWriter]

There's a list at the bottom of the page of some commonly used....

http://en.wikipedia.org/wiki/ACE_inhibitor

Co

[CoWriter]

"Has anyone told you that you see life through IR colored glasses LOL"
-----------------------
ROFL....never that nicely.


"I do think it's an important topic but "
--------------------

It's THE most important host factor in the prediction of response.  I would say it's important.


"especially if someone RVRd."
---------------------
"Exquisitively sensitive to interferon".  Exquisitively sensitive to insulin is what I think they are....LOL  You'll see....one day I'll be proven right.  


"Someone posted a few weeks ago that their doctor already has one patient who needed a transplant, the damage caused by one of the IR drugs."
----------------------
I'm going to have to set a limit to how many times I argue the same topic with you.  And I'll start charging you $23 every time you go above the limit....LOL

Avandia can cause liver failure.  There are 14 reported cases....but NONE with Metformin.

Co

[portann]

I'm home and catching my breath. Hate stairs.

Vertex says NO to only one particular class of blood pressure medication called CALCIUM CHANNEL BLOCKERS. Everything Vertex lists belongs to this class.

So in a nutshell, don't take any calcium channel blockers during treatment, according to Vertex. Simple.

I'm willing to accept that at face value, since I'm not a fan of that class due to tachycardia as a side effect.

The other broad classes are:

1) diuretics
2) betablockers
3) ACE inhibitors
4) ARB's

I have to say diuretics are often the first line of tx in the U.S., so the fact the trial didn't prescribe it but a betablocker instead is interesting. I'm still puzzled if there's a rationale for prescribing a betablocker for BB during tx, given that it's not commonly prescribed anymore.

Co, if ACE's are so much in the cardiology eye, why wasn't he prescribed one? Yes, I love everything I read about it but here I am resistant to it during tx. Sorry to be a pain but I'm perplexed and frustrated at taking the creme de la creme and getting lousy results.

TTYL

[CoWriter]

I found a post written by  BklynBoy81 back in October that says....


"Mom is a diabetic so i get to check my sugar levels once in awhile.. The one reason i found out that i was Hep C Pos was because my sugar would drop to 40.. 40 is kind of scary so i thought i was a diabetic or hyperglycemic and so i got some blood work done"

Now....what were you saying about him not being insulin resistant?

Co

[jmjm530]

You are on record as saying that the chances for RVR are close to zero for someone who is IR going into treatment. BB is super RVR so either you're wrong about that, or he was not IR going into treatment or had it under control. Which is it and I won't even charge you $23.

[CoWriter]

(see my previous post to Jim)

Back in October, what kind of blood test did they do?  What was your fasting blood sugar?  Did they check your insulin level?  How about a 2 hour glucose tolerance test?

You see....when you become insulin resistant (insensitive to insulin), the pancreas works harder and produces more insulin....and sometimes it makes too much and that causes your blood sugar to go down too low.....like maybe 40.

Co

[CoWriter]

This is starting to turn into an interesting thread, isn't it?

I'm very thrifty.  I don't even pay for studies.

Co

[CoWriter]

"Co, if ACE's are so much in the cardiology eye, why wasn't he prescribed one?"
-----------------------------
I have no idea.

Co  

[portann]

I'm not fool enough to become an ACE groupie but I like what I read.

It helps a bit that my cousin, who's adored me since we were little but is excessively blunt, is co-director of a cardiology/metabolic syndrome clinic and likes ACE inhibitors. (BTW, he hates that my husband is taking niacin for his cholesterol.)

He's only a specialist but at least he distrusts drug bandwagons as much as I do. Distrust runs in the family.
-------------------------------------------------------------------------------------------
In answer to your questions:

Jim: I'd be interested in anything you have regarding problems with ARBs.

Port: I remember one article about interaction with ACE, the other about ARB not as good as ACE, but useful if ACE can't be tolerated. You know I'm a lightweight but will do my best to find them. Tomorrow?

Jim: (1) What strength did you try and was it suggested to titrate up?

Port: Started with 2.5 ramipril, and increased every two or three weeks due to resistance in diastolic. 5 ramipril, now 7.5 and doctor wanted me to go up to 10 ramipril but still haven't done it. Afraid to pass out with too beautifully low systolic and stubbornly high diastolic.

Jim: (2) Any side effects

Port: Transient dry cough (a week?) but was really not a nuisance.

Jim: (3) Did it bring down your systolic and how much?

Port: December 14, 2008, 157/101; January 04, 2009, 118/87, January 30, 2009, 96/76.
I want to be at 75 diastolic but feel faint with 96 systolic.


Jim: (4) Have you tried diuretics either with it, or alone? I've read a diuretic can amplify the effects of the ACE but maybe it's just additive.

Port: I do take Ramipril with a baby diuretic to counterbalance high potassium problems with ACE; currently taking 1.25 mg indapamide, down from 2.5, due to potassium going TOO LOW!  Low potassium is the pits. Very easy to fix the low, though.

Jim: Of course it your ACE isn't doing its job then you have to change, what will be your next drug of choice?

Port: Avocados

[CoWriter]

"BB is super RVR so either you're wrong about that, or he was not IR going into treatment or had it under control."
-------------------

Hypoglycemia is a sign of TRANSIENT hyperinsulinemia.  


"so either you're wrong about that"
---------------------
Not today...LOL

Co

[CoWriter]

Jim: Of course it your ACE isn't doing its job then you have to change, what will be your next drug of choice?

Port: Avocados
---------------------
ROFL

[jmjm530]

CO,

I thought u could do better than that. BTW I accept PayPal.

Port,

Thanks. I've got to study up a bit on bp drugs before my next cardio visit so I can guide him properly :) It does seem like some hospitals are pro diuretics and others are def anti and will prescribe Ace Inhibitors first. Hopefully, this is more  philosophical than economical as there is no money in diuretics but much money in the more exotic bp meds.

-- Jim

[BklynBoy81]

i dont think the doctors at the hosiptal did any further testing... they said my blood sugar went to normal...

[BklynBoy81]

doesn't the liver store sugar... every time i tested my blood sugar was in the morning... as soon as i woke up...

[jmjm530]

This is an interesting thread with lots of information but personally I wouldn't stress yourself out. Fact is that your UND at week 2 which bodes very well for SVR. That is a fact. If you still have concerns about your familial IR issues, why don't you ask to speak to your doc and run it by him, or minimally have your NP run it by the doc who I assume is a hepatologist. If they say go ahead with the bp meds, then that is what I would do and not drive yourself crazy. Alternatively, you could suggest an alternative bp med such as an Ace Inhibitor and see what they say. Honestly, either way I don't think you should worry, so far you're doing excellent.

-- Jim

[portann]

You're doing great so far.

You should continue on the atenolol for the time being, according to your rx.

If you can print out Co's list, though, you can bring it along to the nurse at your next visit and ask her if she can get an answer from the trial doc.

---------------------------------------------------------------------------------------------------------------
from Co:

I would ask the doctor to change it.  If he asks why, I would say.....

1.  Because I have a family history of diabetes and beta blockers are known to cause diabetes.
2.  Because interferon can cause insulin resistance/diabetes.
3.  Because PI's can cause insulin resistance.
4.  Because insulin resistance and diabetes can lower SVR greatly.
5.  Because there are better options.

Co

---------------------------------------------------------------------------------------------------------------------

Meanwhile, don't let it knock you off balance.

[portann]

http://general-medicine.jwatch.org/cgi/content/full/2008/1229/8

[CoWriter]

The first thing is not to let your blood pressure get high again by stressing.  The bp med doesn't need to be changed immediately.  You can take this one until you see your doctor again.  

And find out what your fasting blood sugar was and let me know.  Just so I can beat Jim in this discussion.

Co

[CoWriter]

Int J Mol Med. 2008 Oct;22(4):521-7.

Therapeutic effect of ARBs on insulin resistance and liver injury in patients with NAFLD and chronic hepatitis C: a pilot study.

Enjoji M, Kotoh K, Kato M, Higuchi N, Kohjima M, Nakashima M, Nakamuta M.
Department of Clinical Pharmacology, Fukuoka University, Fukuoka 814-0180, Japan.

Fatty liver is one of the local morphological manifestations of metabolic syndrome and is frequently associated with insulin resistance. Insulin resistance is also common in patients with chronic hepatitis C. Hyperinsulinemia is an independent risk factor for hypertension and cardiovascular mortality. The aim of this study was to evaluate the therapeutic efficacy of angiotensin II receptor blockers (ARBs), telmisartan and olmesartan, for patients with non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis C (CH-C). We analyzed the incidence of obesity, insulin resistance, and other disorders in patients with NAFLD (Group A), CH-C (Group B), or other liver diseases (Group C). We evaluated whether the ARBs, telmisartan and olmesartan, improved insulin resistance and liver injury by measuring the homeostasis model assessment ratio of insulin resistance (HOMA-IR) and serum alanine aminotransferase (ALT). The incidence of obesity (BMI > or =25 kg/m2) was significantly higher in Group A than in Groups B and C. The incidence of insulin resistance (HOMA-IR > or =2.5) in Groups A and B was significantly higher than in Group C. Regular doses of telmisartan and olmesartan significantly improved HOMA-IR and ALT levels not only in NAFLD patients but also in patients with CH-C. The effects tended to be more notable with telmisartan. In conclusion, telmisartan and olmesartan improved insulin sensitivity and may possibly be used as liver protecting agents in CH-C as well as NAFLD patients.

http://www.ncbi.nlm.nih.gov/pubmed/18813860?ordinalpos=33&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

[CoWriter]

New study.....

Insulin resistance is a MAJOR determinant of sustained virological response in genotype 1 chronic hepatitis C patients receiving peginterferon alpha-2b plus ribavirin.

Chu CJ, Lee SD, Hung TH, Lin HC, Hwang SJ, Lee FY, Lu RH, Yu MI, Chang CY, Yang PL, Lee CY, Chang FY.
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Background Cross-sectional studies suggest insulin resistance is strongly associated with hepatic steatosis and fibrosis in patients with chronic hepatitis C (CHC), which might affect the efficacy of antiviral therapy. Aim To investigate retrospectively the impact of insulin resistance on treatment response in Chinese genotype 1 CHC patients receiving a 24-week course therapy with peginterferon alpha-2b/ribavirin. Methods A total of 133 biopsy-proven CHC patients were enrolled for analyses. Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR). Hepatic fibrosis was graded by the METAVIR scoring system. Results Mean HOMA-IR progressively elevated along with the severity of hepatic fibrosis (F1-F2 fibrosis: 2.55 +/- 0.16 vs. F3-F4 fibrosis: 3.61 +/- 0.20, P < 0.001). Compared with patients with sustained virological response (SVR), patients without SVR had significantly higher percentages of F3-F4 fibrosis (62.2% vs. 21.6%, P /=600 000 IU/mL; 64.4% vs. 35.6%, P = 0.038). In addition, patients without SVR had significantly higher plasma levels of insulin (15.03 +/- 0.89 vs. 10.19 +/- 0.55 muU/mL, P < 0.001) and HOMA-IR values (3.76 +/- 0.23 vs. 2.50 +/- 0.15, P < 0.001). Multivariate analyses showed that F1-F2 fibrosis (odds ratio: 4.49, P = 0.001), HOMA-IR < 2 (odds ratio: 7.15, P = 0.005) and pre-treatment hepatitis C virus RNA < 600 000 IU/mL (odds ratio: 3.26, P = 0.012) were the independent factors associated with SVR. Conclusions Insulin resistance is a major determinant of SVR in genotype 1 CHC patients receiving peginterferon alpha-2b/ribavirin. Strategies to modify insulin resistance may be effective in enhancing SVR before or during anti-viral therapy.


http://www.ncbi.nlm.nih.gov/pubmed/18680550?ordinalpos=43&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

[jmjm530]

Why are you posting this to me :) This has nothing to do with the previous discussion about BB, his RVR and his high BP. As to the study you posted, this is nothing new nor do I disagree with the premise that IR is detrimental to SVR. We do not have a disagreement regarding IR and SVR, just perhaps when and how to intervene.

-- Jim

[jmjm530]

Interesting on the ARB study and the liver. I had read similar before I took Cozaar but unfort didn't help my bp much is why I may try an Ace Inhibitor next.

[CoWriter]

Isn't it interesting how the HOMA-IR and insulin level was progressively elevated along with the severity of hepatic fibrosis?  you know what that means?  Cirrhotics are IR.

BTW, being a grouch is associated with IR....so is elbow pain, I believe.

LOL

Co

[jmjm530]

BTW, being a grouch is associated with IR....so is elbow pain, I believe.
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How about being dillusional. LOL.