三种抗高血压药物联合应用方案对高血压患者胰岛素抵抗和代谢的影响

Effect of treatment with three prescriptions of hypertensive combination on level of insulin resistance and metabolism in patients with essential hypertension

目的 :研究 3种抗高血压药物联合应用方案对高血压患者胰岛素抵抗 (IR)、血糖和血脂代谢等的影响。方法 :138例轻中度高血压患者被随机分为 3组 ,分别用复方降压片治疗 (第 1组 ,n =39) ,尼群地平和阿替洛尔联合治疗 (第 2组 ,n =5 1) ,福辛普利和吲哚帕胺联合治疗 (第 3组 ,n =4 8) ,疗程 14个月。以根据Cederholm公式计算的胰岛素敏感指数 (ISI)为IR指标 ,口服葡萄糖耐量试验开始 30min后胰岛素和血糖变化的比值 (ΔI30 ΔG30 )为 β细胞胰岛素分泌功能指标 ,观察血压、血糖、血脂等的变化。结果 :1 3组间降压总有效率差异无显著性 [分别为第 1组 94 9% (37 39) ,第 2组 88 2 % (4 5 5 1)、第 3组97 9% (4 7 4 8) ,P >0 0 5 ]。 2 第 1组患者治疗后ISI(治疗前后分别为 5 0 6± 11 8和 5 7 0± 15 4 ,P <0 0 5 )和ΔI30 ΔG30 显著提高 ,血糖显著下降 ,血脂无显著变化。 3 第 2组患者治疗后ISI(治疗前后分别为5 2 1± 16 1和 5 0 2± 15 1,P >0 0 5 )和ΔI30 ΔG30 无显著变化 ,空腹血糖升高和低密度脂蛋白显著升高。4 第 3组患者治疗后ISI显著下降 (治疗前后分别为 5 4 8± 15 7和 4 7 5± 12 5 ,P <0 0 5 ) ,ΔI30 ΔG30 无显著变化 ,血糖、胆固醇和甘油三酯显著升高 。

Objective:To investigate the effect of treatment with three prescriptions of hypertensive combination on blood pressure,level of insulin resistance (IR),glucose tolerance,lipid metabolism etc in patients with essential hypertension(EH).Method:138 patients with mild to moderate EH were randomLy divided into 3 groups:reserpine with dihydralazine,hydrochlorothiazide,potassium chloride group (group 1,n=39),nitrendipine with atenolol group (group 2,n=51) and fosinopril with indapamide group (group 3,n=48).Treatment periol lasted for 14 months.Before and after treatment,IR were measured by calculating insulin sensitivity index (ISI) according to Cederholm' formula and β-cell secretory function were measured by calculating the ration of change in insulin to change in glucose during the first 30 min after glucose ingestion (ΔI 30/ΔG 30).Result:(1)The general responsive rates were not significantly different among 3 groups [group l:94^9%(37/39),group 2:88^2%(45/51),group 3:97^9%(47/48),P>0^05].(2)In group 1 both ISI [(50^6±11^8) vs (57^0±15^4),P<0^05)] and ΔI 30/ΔG 30 were improved markedly,blood glucosewas significantly decreased (P<0^001) and blood lipid was unchanged after treatment.(3) In group 2 both ISI[(52^1±16^1) vs (50^2±15^1),P>0^05] and ΔI 30/ΔG 30 were unchanged,fasting blood glucose and low density lipoprotein-cholesterol were significantly increased (P<0^05) after treatment. (4)In group 3,ISI was significantly decreased [(54^8±15^7) vs (47^5±12^5),P<0^05],ΔI 30/ΔG 30 were unchanged,blood glucose and total cholesterol as well as triglyceride were significantly increased (P<0.01～P<0.001), high density lipoprotein-cholesterol was significantly decreased (P<0^001) after treatment.Conclusion:All of 3 groups are able to control blood pressure efficiently.Treatment of reserpine Combined with dihydralazine,hydrochlorothiazide,potassium chloride has beneficial effect on improving insulin sensitivity and carbohydrate metabolism in EH patients.Treatment of combination of nitrendipine with atenolol does not affect on IR,but worsen cerbohydrate and lipid metabolism in EH patients.Treatment of combination of fosinopril with indapamide deteriorate IR and worsen carbohydrate and lipid metabolism in EH patients.