替米沙坦和缬沙坦对肥胖高血压患者胰岛素抵抗的影响

Effects of Telmisartan and Valsartan on Insulin Resistance in Obese Hypertensive Patients

目的观察替米沙坦和缬沙坦对肥胖高血压患者胰岛素抵抗影响。方法肥胖标准为体重指数(BMI)≥25 kg·(m2)-1的原发性高血压患者68例,随机分为替米沙坦组33例和缬沙坦组35例,服药前及服药16周后监测血压、空腹血糖、空腹胰岛素(Fins)及胰岛素抵抗指数(HOMA-IR)。结果两组服药前后比较,收缩压/舒张压差异均有统计学意义(P<0.01)。替米沙坦组治疗前和治疗16周后Fins分别为(12.9±2.5),(10.9±2.2)m U·L-1,HOMA-IR分别为(3.1±0.7),(2.5±0.8)(均P<0.01),缬沙坦组治疗前和治疗16周后Fins分别为(13.3±4.7),(14.5±4.1)m U·L-1,HOMA-IR分别为(3.2±1.4),(3.2±1.0)(均P>0.05)。两组治疗后Fins和HOMA-IR比较差异有统计学意义(P<0.01)。结论替米沙坦和缬沙坦有等同的降压效应,但替米沙坦在改善肥胖高血压患者胰岛素抵抗方面优于缬沙坦。

Objective To observe the effects of telmisartan and valsartan on insulin resistance in obese hypertensive patients. Methods Sixty-eight patients with essential hypertension and body mass index （BMI） ≥ 25 kg ·（m2）-1 were randomly divided into the telmisartan group （33 cases） and valsartan group （35 cases）. Blood pressure, fasting serum glucose, fasting insulin （Fins） and insulin resistance （HOMA-IR） were measured before and after 16 weeks treatment. Results Compared with basal levels, SBP and DBP were significantly decreased in both group （P〈0.01）. Fins and HOMA-IR were significantly decreased in telmisartan group [ （ 12.9±2.5 ） mU · L-1 vs. （ 10.9 ±2.2） mU ·L-1 （ P〈0.01 ） ; （ 3.1 ±0.7 ） vs. （2.5±0.8） （P〈0.01）, respectively], while no such changes were found in valsartan group [ （13.3±4.7） mU · L-1 vs. （14.5±4.1） mU · L-1（p〉0-05）;（3.2±1.4） vs. （3.2±1.0） （P〉0-05）, respectively]. Conclusion In obese hypertensive patients, telmisartan and valsartan exert similar antihypertensive effect, but telmisartan may have a benefit in insulin resistance in comparison to valsartan.