Endothelin antagonism reduces hemoglobin A1c in patients with pulmonary hypertension

Our lab recently reported that the blockade of endothelin-1 (ET-1) receptors attenuates insulin resistance in obese mice; therefore, we hypothesized that patients taking ET-1 receptor antagonists (ERAs) will have improved glycemic control. University of Mississippi Medical Center (2013-2020) electronic health record (EPIC) data were extracted from patients >= 18 years old with a clinical diagnosis of pulmonary hypertension (Food and Drug Administration indication for ERA use) and at least two clinical visits within 2 years. Patients prescribed ERAs (n = 11) were similar in age (61 +/- 14 years vs. 60 +/- 14 years), body mass index (BMI) (34 +/- 8 kg/m(2) vs. 35 +/- 11 kg/m(2)), diabetes prevalence (73% vs. 80%, p = 0.59), and follow-up time (209 +/- 74 days vs. 283 +/- 180 days) compared with patients not taking ERAs (n = 137). There was a small but similar decrease in BMI at follow-up in the ERA (-1.9 +/- 3 kg/m(2)) and control patients (-1.6 +/- 5 kg/m(2)). At follow-up, hemoglobin A1c (HbA1c) significantly decreased -12% +/- 11% of baseline in patients taking ERAs, while this did not occur in the control patients (2% +/- 20% increase in HbA1c). In the whole population, baseline HbA1c and ERA prescription predicted the fall in HbA1c, while there was no significant association with demographics, diabetes prevalence, and diabetic treatment. These data suggest a potential role of ET-1 in promoting insulin resistance and warrant further investigation into using these drugs for glycemic control.

Automated summary

Our lab recently reported that blockade of ET-1 receptors attenuates insulin resistance in obese mice. In this study, we investigated the potential benefits of ET-1 receptor antagonists (ERAs) on glycemic control in patients with pulmonary hypertension. The results showed that patients taking ERAs had significantly improved hemoglobin A1c (HbA1c) levels compared to control patients.