替米沙坦对肥胖高血压患者胰岛素抵抗和血清视黄醇结合蛋白4水平的影响

Effects of telmisartan on insulin resistance and serum retinol-binding protein 4 in patients with essential hypertension

目的:观察替米沙坦对伴超重或肥胖的高血压患者血压、糖脂代谢指标和血清视黄醇结合蛋白4(RBP4)水平的影响。方法:将45例门诊超重或肥胖的原发性高血压患者随机分为替米沙坦组(n=23)和氯沙坦组(n=22),分别给予替米沙坦80 mg(qd)或氯沙坦100 mg(qd),必要时加用长效钙拮抗剂,治疗16周。观察用药前后腰围、腰臀比、体质量指数、血压、空腹血糖、胰岛素、血脂和血清RBP4含量的变化。采用稳态模式法计算胰岛素抵抗指数(HOMA-IR)。结果:两组治疗后,收缩压及舒张压与治疗前比较均明显下降,替米沙坦组分别降低20.5 mmHg和14.8mmHg,氯沙坦组分别降低18.3 mmH和14.2 mmHg,下降幅度组间比较无差异;替米沙坦组HOMA-IR和血清RBP4的含量明显下降,分别由7.24±1.82下降至6.02±2.16(P<0.05)和(46.9±15.0)mg/L下降至(39.8±14.8)mg/L(P<0.05)。结论:替米沙坦可改善肥胖伴高血压患者的胰岛素敏感性、降低血清RBP4的水平。

AIM： To investigate the effects of telmisartan on insulin resistance and serum retinol-binding protein 4 in patients with essential hypertension.METHODS： Forty-five subjects with essential hypertension were treated with telmisartan（80 mg/day） or losartan（100 mg/day） combined with long-acting calcium antagonist,if necessary,for 16 weeks.Waist and hip circumference,body mass index,blood pressure,fasting plasma glucose（FPG）,insulin（FPI）,lipid and retinol-binding protein 4（RBP4） were measured before and after the treatment.Insulin sensitivity was estimated by homeostasis model assessment（HOMA-IR）.RESULTS： Compared with baseline levels,systolic and diastolic blood pressure decreased significantly in both groups.But the levels of HOMA-IR and RBP4 decreased significantly only in telmisartan group.CONCLUSION： Telmisartan improves insulin resistance and decreases serum RBP4 level in patients with essential hypertension.