胰岛素增敏剂罗格列酮抗高血压作用探讨

Anti hypertensive effect of rosiglitazone in non diabetic essential hypertension

目的 观察胰岛素增敏剂马来酸罗格列酮在超重和 (或 )肥胖的轻、中度高血压患者的降血压作用及其影响因素 ,探讨胰岛素增敏剂用于原发性高血压治疗或辅助治疗的可能性。方法 超重及肥胖 (体重指数≥ 2 5kg/m2 )的非糖尿病轻、中度原发性高血压 [14 0mmHg <收缩压 <190mmHg ,(1mmHg =0 133kPa) ]患者 89例。测定口服葡萄糖耐量试验各时点血糖及胰岛素浓度 ,排除糖尿病。原服用降血压药物者停用药物 2周后进入试验 ,原生活方式不变。仅服用胰岛素增敏剂马来酸罗格列酮 8mg/d ,疗程 4周。分析血压下降情况及影响因素。 结果 (1)治疗 4周后收缩压平均降低了 17mmHg ,舒张压平均降低了 11mmHg。 (2 )治疗后比治疗前空腹、糖负荷后 1h及 2h血胰岛素水平分别下降 2 7%、35 %、4 1% (P <0 0 0 0 1)。胰岛素敏感性改善了 30 % (P <0 0 0 0 1)。(3)在基线血压水平较高、胰岛素抵抗程度较严重及无高血压家族史的患者中罗格列酮的降压幅度更大。结论 马来酸罗格列酮对超重或肥胖非糖尿病人群显示了良好的抗高血压效能 ,提示此类胰岛素增敏剂可能在某些人群原发高血压治疗或辅助治疗中有一定价值。

Objective To investigate blood pressure lowering effect of rosiglitazone in overweight/obese non diabetic patients with hypertension to explore the therapeutic role of insulin sensitizers in the management of essential hypertension Methods 89 cases of overweight/obese non diabetics with essential hypertension were enrolled in a 4 weeks open label clinical trial Rosiglitazone 8 mg/day were started 2 weeks after withdrawing previously used anti hypertensive medications Blood pressure was measured at the 2nd and 4th week Plasma glucose and insulin levels during oral glucose tolerance test (OGTT) at baseline and at 4th week were also determined Results After 4 weeks treatment with rosiglitazone, the mean systolic and diastolic blood pressure reduced by 17 mm Hg (1mm Hg=0 133 kPa) and 11 mm Hg, respectively Plasma insulin levels at fasting, 1 and 2 hour during OGTT decreased by 27%, 35% and 41%, respectively ( P <0 001), whereas insulin sensitivity increased by 30% ( P <0 001) The amplitude of reduction of blood pressure was related to the baseline level of blood pressure and insulin sensitivity, and family history of hypertension Conclusions Rosiglitazone significantly reduces blood pressure in overweight and/or obese non diabetic subjects with hypertension Randomized controlled clinical trial is justified to confirm the therapeutic role of rosiglitazone in the management of non diabetic essential hypertension