氯沙坦钾对老年单纯收缩期高血压患者血压及胰岛素敏感性的影响

Effects of losartan potassium on blood pressure and insulin sensitivity in aged patients with isolated systolic hypertension

目的：探讨氯沙坦钾对老年单纯收缩期高血压患者血压及胰岛素抵抗的影响。方法：选择2004年1月至2007年3月的105例门诊老年单纯收缩期高血压患者，采用氯沙坦钾50～100mg／d，口服，治疗8周，检测治疗前后血压、空腹血葡萄糖、空腹胰岛素、胰岛素敏感指数，观察不良反应。结果：治疗2周后患者收缩压明显降低并达到目标水平（与治疗前相比，P〈0．01），血压无明显波动，至第8周时总有效率达88．6％，对舒张压和空腹血糖无明显影响；此外至治疗结束时，患者空腹胰岛素水平明显低于治疗前[分别为（19．8±3．9）mmol／L和（12．5±2．7）mmol／L，P〈0．053，胰岛素敏感性较治疗前明显改善[敏感性指数分别为-（4．42±0．35）和-（4．11±0．26），P〈0．05]，仅5例（4．8％）出现轻微头昏、咳嗽。结论：氯沙坦钾不仅能够有效控制老年单纯收缩期高血压患者血压而且还可改善其胰岛素敏感性。

Objective： To investigate the effects of losartan potassium on blood pressure and insulin sensitivity in aged patients with isolated systolic hypertension （ISH）. Methods： Between January, 2004 and March, 2007, 105 aged patients with ISH were enrolled, who were administrated orally with losartan potassium at a dose of 50 to 100 mg per day for eight weeks. Before and after treatment, blood pressure （BP）, fasting blood glucose （FBG）, fasting insulin （FINS） and insulin sensitive index （ISI） were determined. The adverse effects were recorded during follow-up period. Results： Two weeks after treatment, systolic BP （SBP） of patients decreased significantly and reached to the target level （P〈0.01）. After this, SBP did not significantly fluctuated up to eight weeks after treatment. The total effective rate was 88.6%. The FINS level of patients decreased and ISI of patients significantly improved at the end of treatment when compared with that before treatment （P〈0.05）. In the whole follow-up period, the FBG and diastolic BP （DBP） did not change obviously, and only trivial dizzy or cough happened in 5 patients （4.8%）. Conclusion： Losartan potassium can effectively control BP and significantly improve ISI in aged patients with ISH.