Some interesting info:
[URL unfurl="true"]https://academic.oup.com/ajh/article/13/S4/106S/186242[/URL]
Improvement in insulin resistance
The effects of rilmenidine were studied recently in patients with metabolic syndrome (syndrome X). Fifty-two patients with obesity, hypertension, impaired glucose tolerance, and hypertriglyceridemia (body mass index ≥ 29 kg/m2, 95 ≤ DBP ≤ 114 mm Hg, TG ≥ 2 mmol/L, 6.1 ≤ fasting plasma glucose ≤ 7.0 mmol/L or 7.8 ≤ plasma glucose at 2 h on an oral glucose tolerance test ≤ 11 mmol/L) were included. They were treated with rilmenidine (1 to 2 mg daily) for 5 months. Rilmenidine significantly improved glucose metabolism compared with amlodipine, as judged on the oral glucose tolerance test by significant reduction in plasma glucose at 2 h and in the area under the curve. These findings suggest a specific effect of rilmenidine on insulin resistance, most likely mediated by reduction in sympathetic overdrive.14
Thus, in addition to the well-demonstrated antihypertensive efficacy, and clinical and metabolic tolerability of rilmenidine, use in at-risk hypertensive patients is supported by specific benefits in those with ventricular hypertrophy, diabetic microalbuminuria, and impaired glucose tolerance.