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目的观察氯沙坦钾片与苯磺酸左旋氨氯地平片对空腹血糖异常的高血压病患者胰岛素抵抗的影响。方法选择既往无糖尿病史,空腹血糖>5.6 mmol/L且口服75 g无水葡萄糖耐量试验(oral glucose tolerance test,OGTT)后2 h PG<7.8 mmol/L的原发性高血压患者200例,随机分为2组,每组各100例,分别给予氯沙坦钾片(50～100 mg/d,根据患者个体差异而定)或苯磺酸左旋氨氯地平片(2.5～5.0 mg/d,根据患者个体差异而定)强化降压治疗12个月,并同时给予生活方式干预,在血压达标(BP<130/80 mmHg)的情况下,对比其治疗前后空腹胰岛素(fasting insulin,FINS)、OGTT2 h后胰岛素(2 hours fasting insulin,2 h INS)及胰岛素敏感指数(insulin sensitive index,ISI)的变化情况。结果 2组治疗后血压均较治疗前明显下降(P<0.05),治疗后氯沙坦钾组FINS水平下降,ISI较治疗前明显改善(P<0.05),与苯磺酸左旋氨氯地平组比较,差异具有统计学意义(P<0.05)。磺酸左旋氨氯地平组FINS、ISI治疗前后无明显变化(P>0.05)。治疗后2组2 h INS均无明显改善(P>0.05)。结论对于空腹血糖异常的高血压患者,氯沙坦钾较苯磺酸左旋氨氯地平更具有改善胰岛功能、降低胰岛素抵抗的优势,但两者对餐后胰岛素水平无明显作用,考虑与空腹血糖异常发病机制有关。
Objective To observe the effects of losartan potassium and levamlodipine besilate on insulin resistance in patients with hypertension with impaired fasting glucose. Methods 200 patients with essential hypertension who had no previous history of diabetes, fasting blood glucose> 5.6 mmol / L and oral glucose tolerance test (OGTT) 2 h after PG <7.8 mmol / L were enrolled in this study. Randomly divided into two groups of 100 patients in each group, respectively losartan potassium tablets (50 ~ 100 mg / d, depending on individual patient may be) or levamlodipine besylate tablets (2.5 ~ 5.0 mg / d , Depending on the patient’s individual differences) intensified antihypertensive treatment for 12 months, and at the same time give lifestyle interventions. When blood pressure reached (BP <130/80 mmHg), fasting insulin (FINS) , 2 hours fasting insulin (2 h INS) and insulin sensitive index (ISI) after OGTT were measured. Results After treatment, the blood pressure in both groups decreased significantly (P <0.05). After treatment, the levels of FINS in losartan potassium group were significantly decreased, and the ISI was significantly improved (P <0.05) compared with that before treatment. Compared with levamlodipine besylate group The difference was statistically significant (P <0.05). The levamlodipine sulfonate group FINS, ISI no significant changes before and after treatment (P> 0.05). After 2 h of treatment, there was no significant improvement in INS (P> 0.05). Conclusion For patients with hypertension with impaired fasting glucose, losartan potassium is more effective than levoamlodipine besylate in improving islet function and reducing insulin resistance. However, both of them have no significant effect on postprandial insulin level, Abnormal pathogenesis.