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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。
Objective: To observe the effects of telmisartan on blood pressure, glucose and lipid metabolism and serum retinol binding protein 4 (RBP4) levels in hypertensive patients with overweight or obesity. Methods: Forty-five patients with overweight or obesity in primary hypertension were randomly divided into telmisartan group (n = 23) and losartan group (n = 22), and were given telmisartan 80 mg ) Or losartan 100 mg (qd), if necessary, add long-acting calcium antagonist for 16 weeks. Waist circumference, waist-hip ratio, body mass index, blood pressure, fasting blood glucose, insulin, serum lipids and serum RBP4 levels were observed before and after treatment. Insulin resistance index (HOMA-IR) was calculated using the steady state model. Results: The systolic blood pressure and diastolic blood pressure decreased significantly after treatment in both groups, with 20.5 mmHg and 14.8 mmHg respectively in the telmisartan group and 18.3 mmH and 14.2 mmHg in the losartan group, respectively The levels of HOMA-IR and serum RBP4 in telmisartan group decreased significantly from 7.24 ± 1.82 to 6.02 ± 2.16 (P <0.05) and (46.9 ± 15.0) mg / L to (39.8 ± 14.8) mg / L (P <0.05). Conclusion: Telmisartan can improve the insulin sensitivity and reduce the level of RBP4 in obese patients with hypertension.