性别对高血压患者抗高血压药物治疗后糖和血脂代谢的影响

Effect of sex on lipids and glucose metabolism after antihypertensive therapy in patients with essential hypertension

目的 :研究性别对原发性高血压 (EH)患者抗高血压药物治疗后胰岛素抵抗 (IR)、血糖和血脂变化的影响。方法 :1 3 3例轻中度EH患者被随机分为 3组 ,分别用复方降压片治疗 (第 1组 ,3 9例 ) ,福辛普利和吲哚帕胺联合治疗 (第 2组 ,48例) ,尼群地平和阿替洛尔联合治疗 (第 3组 ,46例 ) ,每组分为男、女性两亚组。疗程 1 4个月。以根据Cederholm公式计算的胰岛素敏感指数 (ISI)为IR指标 ,观察血压、血糖、血脂的变化。结果 :①第 1组和第 2组的降压效果 ,女性比男性显著 ;性别对第 3组的降压效果无显著影响。②第 1组患者治疗后男女两亚组ISI升高和血糖下降的幅度、血脂的变化差异均无统计学意义。③第 2组患者治疗后男女两亚组ISI下降、血糖升高和高密度脂蛋白 /低密度脂蛋白比下降的幅度差异无统计学意义。④第 3组患者治疗后男性亚组血糖显著升高 ,高密度脂蛋白 /低密度脂蛋白比显著下降 ,ISI差异无统计学意义 ;女性组血糖、血脂和ISI无统计学意义。结论 :性别对长期用复方降压片治疗引起的EH患者胰岛素敏感性和糖代谢改善无影响 ;对长期福辛普利和吲哚帕胺联合治疗引起的IR加重及血糖和血脂代谢恶化无影响 ;长期尼群地平和阿替洛尔联合治疗不利于男性EH患者血糖和血脂代谢 。

Objective: To investigate the effect of sex on changes in insulin resistance (IR), level of blood glucose and blood lipid after antihypertensive treatment in patients with essential hypertension (EH). Method:One hundred and thirty-three patients with mild to moderate EH were randomly divided into 3 groups: reserpine with dihydralazine, hydrochlorothiazide, potassium chloride group (group 1, n=39), fosinopril with indapamide group (group 2, n=48) and nitrendipine with atenolol group (group 3, n=46). Treatment period lasted for 14 months. Every group was divided into male subgroup and female subgroup. Before and after treatment, IR was measured by calculating insulin sensitivity index (ISI) according to Cederholm' formula. Result: ①The value of blood pressure falling per unit antihypertensive dosage was significantly greater in female than in male in both group 1 and group 2, and was not significantly different between male and female subgroup of group 3. ②After treatment, both the range of ISI increase and blood glucose decrease were not significantly different between male and female subgroup, and blood lipid was unchanged in group 1. ③After treatment, both ISI and high density lipoprotein-cholesterol (HDL-C)/low density lipoprotein-cholesterol (LDL-C) ratio were significantly decreased and blood glucose was significantly increased in male and female subgroup of group 2. ④After treatment, blood glucose was significantly increased and HDL-C/LDL-C ratio was significantly decreased in male subgroup, however, there were significant changes in ISI, blood glucose and blood lipid in female subgroup of group 3. Conclusion: There are not effect of sex on improving insulin sensitivity and carbohydrate metabolism with treatment of combination of reserpine with dihydralazine, hydrochlorothiazide, potassium chloride, and embittering IR and worsening carbohydrate and lipid metabolism with treatment of combination of fosinopril with indapamide in patient with EH. Treatment of combination of nitrendipine with atenolol goes against carbohydrate and lipid metabolism in male, however, does not in female patients with EH.