Role of Mineralocorticoid Receptor in Diabetic Cardiovascular Disease

Inclusion criteria

• age 18-70 years
• type 2 diabetes mellitus
• with or without hypertension

Exclusion criteria

• ischemic changes on resting electrocardiogram,
• clinical evidence of heart disease (angina, heart failure, unstable angina),cerebrovascular or peripheral vascular disease,
• significant cardiac arrhythmias,
• aortic stenosis,
• 2nd or 3rd degree atrio-ventricular block, sinus node disease, or symptomatic bradycardia,
• bronchospastic lung disease with active wheezing,
• known hypersensitivity to adenosine,
• hemoglobin A1C (HbA1c) > 8.5%, *
• gout (If not already taking HCTZ),
• the use of Rosiglitazone,**
• estimated glomerular filtration rate (eGFR) < 60 ml/min,
• serum potassium > 5.0 mmol/L,
• use of potassium-sparing diuretics,**
• current smoker,*
• pregnancy,
• renal disease not related to diabetes mellitus,
• uncontrolled hypertension, systolic blood pressure (BP) >160 mm Hg and diastolic BP >100 mm Hg,*
• use of cyclic hormone replacement therapy
• past intolerance of angiotensin-converting enzyme (ACE) inhibitor therapy
• other major medical illnesses. Participants with evidence of a previous myocardial infarction on the first adenosine-stimulated positron emission tomography (PET) study will be withdrawn from the study.
• Screening systolic blood pressure < 105 mm Hg off of anti-hypertensive medications

• Participants can enroll in study and proceed with in-patient evaluations if during the run-in period adjustments of medications, diet and habits lead to improved glucose control [equivalent to HbA1c <8.5%, controlled hypertension and cessation of smoking.

• Participants who are currently taking these medications will not qualify for a screening visit. If medications were recently stopped by the participant's physician, he or she may be screened but the baseline assessment protocol must occur 3 months after stopping.