替米沙坦对老年高血压伴代谢综合征患者糖代谢的改善作用

Effect of Telmisartan on Glucose Metabolism in Aged Hypertensive Patients with Metabolic Syndrome

目的探讨替米沙坦对老年高血压伴代谢综合征患者糖代谢的影响。方法选择70例老年轻中度高血压伴代谢综合征患者,将其随机分配至替米沙坦组和硝苯地平组,各35例。替米沙坦组给予替米沙坦40 mg/d治疗,硝苯地平组给予硝苯地平30 mg/d治疗,服药6个月。比较治疗前后两组患者的糖脂代谢指标的变化。结果两组患者血压均控制良好,治疗前后收缩压及舒张压间差异均无统计学意义(P>0.05)。替米沙坦组治疗前后空腹胰岛素〔(10.4±4.4)μU/ml与(6.8±2.3)μU/ml,P<0.01〕及餐后2 h血糖水平〔(8.7±1.3)mmol/L与(7.1±0.9)mmol/L,P<0.01〕显著下降,HOMA-IR亦显著下降〔(2.5±1.2)与(1.7±0.7),P<0.01〕,早期胰岛素分泌功能指数(△I30/△G30)显著升高〔(10.4±1.9)与(15.7±2.9),P<0.01〕;治疗后上述指标与硝苯地平组比较,差异均有统计学意义(P<0.01)。硝苯地平组治疗前后各糖脂代谢指标均无显著变化。结论替米沙坦在良好降压的同时,可改善老年高血压伴代谢综合征患者的胰岛素敏感性和早期胰岛素分泌功能。

Objective To investigate the effect of telmisartan on glucose metabolism in aged hypertensive patients with metabolic syndrome. Methods Seventy aged patients with mild or moderate hypertension complicated by metabolic syndrome were divided randomly into groups T （telmisartan） and N （nifedipine）, 35 in each. T group were treated with telmisartan （40 mg/d）, and N group with nifedipine （30 mg/d）, 6 months. The changes of glucose and lipid metabolism were compared between pre - and post - treatments. Results Blood pressure was well controlled in 2 groups, the difference in systolic and diastolic blood pressure was not significant between pre - and post - treatments （ P 〉 0. 05 ）. In T group, pre - and post - treatment fasting insulin （10.4 ±4.4 μU/ml, 6. 8 ± 2. 3 μU/ml, respectively）, postprandial 2 h blood glucose （8.7± 1.3 mmol/L, 7.1 ±0. 9 mmoL/L, respectively） and HOMA - IR （2. 5 ± 1.2, 1.7 ± 0.7, respectively） decreased significantly （ P 〈 0. 01 ）, and early insulinogenic index （ △I30/△G30 ） increased significantly （ 10. 4 ± 1.9, 15.7 ± 2.9, respectively） （ P 〈 0. 01 ） ; There was significant difference in the above parameters between 2 group after treatment （ P 〈 0. 01 ）. No obvious changes were noted in pre - and post - treatment glucose and lipid metabolism in N group. Conclusion Telmisartan can not only decrease blood pressure but also improve insulin sensitivity and early insulin secretion function in aged patients with hypertension complicated by metabolic syndrome.