替米沙坦对老年高血压伴糖尿病患者左室肥厚的治疗作用

Effect of telmisartan on left ventricular hypertrophy in elderly patients with diabetes mellitus and essential hypertension

目的探讨替米沙坦对老年高血压伴有糖尿病患者空腹血糖、血清胰岛素、胰岛素抵抗指数及左室肥厚的影响。方法选择老年高血压伴有糖尿病左室肥厚患者120例,随机分为替米沙坦(口服80～160mg/d)组或培哚普利(口服4～8mg/d)组,每组60例,均治疗8个月。治疗前、后检测空腹血糖、血清胰岛素、胰岛素抵抗指数及超声心动图,对比分析治疗前、后上述指标的差异。结果与治疗前比较,替米沙坦组和培哚普利组治疗后收缩压和舒张压明显下降(159/101至142/89mmHg;161/103至145/90mmHg,均为P<0.01);(2)替米沙坦治疗后,空腹血糖、血清胰岛素及胰岛素抵抗指数明显降低〔(8.2±0.9)至(7.3±0.7)mmol/L,(12.8±0.9)至(7.5±0.6)pmol/L及(4.7±0.4)至(4.1±0.3),均为P<0.05〕,左室后壁与室间隔厚度显著下降〔(1.27±0.28)至(1.09±0.21)cm,(1.28±0.31)至(1.09±0.27)cm,均P<0.05〕,左室重量及左室重量指数下降更显著〔(264±98)至(205±62)g,(165±60)至(128±34)g/m2,均为P<0.01〕;培哚普利组治疗后空腹血糖、血清胰岛素、胰岛素抵抗指数无明显的变化,左室后壁与室间隔厚度亦无明显的变化,左室重量及左室重量指数下降显著〔(260±94)至(225±72)g;(163±58)至(139±37)g/m2,均为P<0.05〕。结论替米沙坦在提高胰岛素的敏感性、

Objective To explore the effect of angiotensin Ⅱ antagonist on left ventricular hypertrophy(LVH) and insulin resistance in elderly patients with diabetes mellitus and hypertension. Methods One hundred and twenty elderly patients with diabetes mellitus and essential hypertension with LVH by echocardiography entered the study. Patients were randomized into the telmisartan (80～160 mg/d) group or perindopril (4～8 mg /d) group. After treatment of telmisartan or perindopril,patients were followed-up for 8 months.Plasma sample was collected from each patient before and after treatment of telmisartan or perindopril,respectively.Then plasma levels of cholesterol,fasting plasma glucose(FPG), insulin and Homeostasis Model Assessment Insulin Resistance (HOMA-IR) were investigated.The echocardiography before and after 8 months of treatment with telmisartan or perindopril were also examined. Results Data were analyzed and showed that: (1)After 8 months of treatment with telmisartan or perindopril, blood pressure was reduced from 159/101 to 142/89 mm Hg(P<0.01) or from 161/103 to 145/90 mm Hg (P<0.01) respectively.(2)At the end of 8 months,patients treated with telmisartan produced significant improvement in FPG,insulin and HOMA-IR compared to perindopril group.Both telmisartan group and perindopril group showed no change in total cholesterol,HDL-C and triglyceride.(3)Left ventricular mass index decreased from 165 g/m 2 to 128 g/m 2 (P<0.01) or from 163 to 139 g/m 2 (P<0.05) respectively. Conclusions Telmisartan shows a clinically meaningful reduction in the plasma levels of FPG,insulin,HOMA-IR and LVH.And telmisartan is through effects of blockade of the renin-angiotensin system, and activating peroxisome proliferator-activatorsγ(PPARγ) exert it's benefit effect to elderly patients with diabetes mellitus and hypertension.