雷米普利和缬沙坦对高血压病患者胰岛素抵抗及血管活性物质的影响

EFFECTS OF VALSARTANON AND RAMIPRIL ON INSULIN RESISTANCE AND VASCULAR ACTIVE SUBSTANCE IN PATIENTS WITH PRIMARY HYPERTENSION

目的 探讨雷米普利和缬沙坦对胰岛素抵抗及血管活性物质的影响。方法 对 70例高血压患者随机分成缬沙坦组 36例及雷米普利组 34例 ,测定治疗前与治疗后 4周血浆血管紧张素Ⅱ (AngⅡ )、醛固酮 (ALD)、内皮素(ET - 1 )、血糖 (SG)及胰岛素 (insulin)水平 ,并计算胰岛素敏感性指数 (ISI)、观察治疗前后血压及 2 4h动态血压变化。结果 (1 )雷米普利和缬沙坦治疗 4周后血压水平均显著下降 ,缬沙坦组收缩压从 (1 60± 1 3)mmHg降至(1 4 5± 1 2 )mmHg ,舒张压从 (99± 8)mmHg降至 (80± 7)mmHg;雷米普利组收缩压从 (1 61± 1 2 )mmHg降至 (1 4 4± 1 1 )mmHg ,舒张压从 (98± 9)mmHg降至 (79± 8)mmHg ;(2 )缬沙坦对 2 4h平均舒张压及降压的谷峰比值均大于雷米普利组 ;(3)缬沙坦组血浆AngⅡ水平升高 ,ALD、ET - 1降低 ,胰岛素敏感性指数升高。雷米普利组血浆AngⅡ水平、ALD及ET - 1均降低 ,胰岛素敏感性指数升高。结论 雷米普利和缬沙坦对血浆AngⅡ水平影响不同 ,但两者降压均安全、有效 。

Objective\ To study effects of valsartanon and ramipril on insulin resistance and vascular active substance in patients with essential hypertension.Methods\ 70 patients with essential hypertension were randomized into valsartanon group (n=36) and ramipril group (n=34). Fasting plasma AngⅡ,aldosterone(ALD), endothelin (ET-1), glucose, insulin were measured and insulin sensitivity index (ISI) was calculated, 24 h ambulatory Bp monitor were used in patients with essential hypertension before and 4-week treatment with valsarta non and on ramipril.Results\ (1)The blood pressure decreased significantly after 4-week treatment with valsartanon and ramipril.In group of valsartan,the systolic blood pressure decreased from (160±13) mmHg to (145±12) mmHg (1 mmHg=0.133 kPa),and the diastolic Bp decreased from (99±8) mmHg to (80±7) mmHg,P<0.01.In group of ramipril, the systolic blood pressure decreased from (161±12) mmHg to (144±11) mmHg,and the diastolic Bp decreased from (98±9) mmHg to (79±8) mmHg,P<0.01.(2)Valsartanon had the same effects on hypertension as ramipril. especially in reducing of 24 h DBP, and had good T/P ratio than ramipril.(3) Plasma AngⅡand ISI increased,the ALD and ET-1 reduced in valsartan group. Plasma AngⅡ, ISI,ALD and ET-1 reduced in valsartanon group.The index of insulin sensitivity was increace in two groups.Conclusion\ Valsartanon and ramipril are effective and safe drug of management for patients with essential hypertension,and they might also improved the endothelial function and reduce the insulin resistance state.