Ambulatory blood pressure reduction after rosiglitazone treatment in patients with type 2 diabetes and hypertension correlates with insulin sensitivity increase
Ambulatory blood pressure reduction after rosiglitazone treatment in patients with type 2 diabetes and hypertension correlates with insulin sensitivity increase
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DOI：
10.1097/00004872-200409000-00022
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发表时间：
2004-09-01
影响因子：
4.9
通讯作者：
Tourkantonis, AN
中科院分区：
文献类型：
--
作者：
Sarafidis, PA;Lasaridis, AN;Tourkantonis, AN
在代谢综合征中，胰岛素抵抗和代偿性高胰岛素血症通过多种潜在机制与血压升高相关。噻唑烷二酮类药物是降低胰岛素抵抗的降糖药。目的探讨噻唑烷二酮罗格列酮对2型糖尿病合并高血压患者血压及胰岛素抵抗的影响。方法对血糖控制较差的2型糖尿病患者20例（男9例，女11例），同时伴有控制较差或新诊断为高血压的患者，给予罗格列酮4mg /天的加药治疗，疗程26周。在基线和治疗期结束时，患者接受动态血压监测、高胰岛素正血糖钳夹、血糖、胰岛素、HbA（1c）、血脂和常规实验室参数的血液检查。结果胰岛素敏感性在格列酮治疗期间显著增加（M-bw/I指数从33.9 +/- 2.6变为41.9 +/- 3.2 mumol/min / kg / nmol/I, P < 0.001）， HOMA-IR指数显著降低（6.34 +/- 0.39 vs 4.40 +/- 0.33, P < 0.001）。在24小时的总时间内，白天和夜间的动态血压（135.3 +/- 1.8对129.9 +/- 1.7 mmHg，收缩压P < 0.001, 76.0 +/- 1.6对71.9 +/- 1.6 mmHg，舒张压P < 0.001）均呈现小而显著的降低。收缩压、舒张压变化与胰岛素敏感性变化相关（r = -0.78, P < 0.01）；空腹血糖（9.39 +/- 0.41 vs 7.55 +/- 0.31 mmol/l, P < 0.001）、胰岛素（94.0 +/- 0.41 vs 79.5 +/- 5.6 pmol/l, P < 0.01）和HbA(1c) （8.15 +/- 0.24 vs 7.24 +/- 0.19%, P < 0.001）也有显著降低。结论罗格列酮治疗2型糖尿病高血压患者可显著提高胰岛素敏感性，降低血压。这些变化是密切相关的。因此，噻唑烷二酮类药物可能具有除降糖外的降压作用。(C) 2004利平科特·威廉姆斯·威尔金斯。
Background Within the metabolic syndrome, insulin resistance and compensatory hyperinsulinemia are associated with blood pressure (BP) elevation through various potential mechanisms. Thiazolidinediones are antihyperglycemic agents that decrease insulin resistance.Objective To determine the effect of the thiazolidinedione rosiglitazone on BP and insulin resistance in patients with type 2 diabetes and hypertension.Methods In 20 subjects (nine men and 11 women) with type 2 diabetes but with a poor glycemic control, and with poorly controlled or newly diagnosed hypertension, rosiglitazone 4 mg daily was added-on therapy for 26 weeks. At baseline and at the end of the treatment period patients underwent ambulatory blood pressure monitoring, a hyperinsulinemic euglycemic clamp, and blood tests for glucose, insulin, HbA(1c), lipids, and routine laboratory parameters.Results Insulin sensitivity estimated with the clamp significantly increased (M-bw/I index changed from 33.9 +/- 2.6 to 41.9 +/- 3.2 mumol/min per kg per nmol/I, P < 0.001) and the HOMA-IR index significantly decreased (6.34 +/- 0.39 versus 4.40 +/- 0.33, P < 0.001) during rosiglitazone treatment. Ambulatory BP presented small but significant reductions for the total 24-h period (135.3 +/- 1.8 versus 129.9 +/- 1.7 mmHg, P < 0.001 for systolic BP and 76.0 +/- 1.6 versus 71.9 +/- 1.6 mmHg, P < 0.001 for diastolic BP), daytime and night-time. The changes in systolic and diastolic BP correlated with the change in insulin sensitivity (r = -0.78, P < 0.01 and r = -0.68, P < 0.01, respectively). There were also significant reductions in fasting plasma glucose (9.39 +/- 0.41 versus 7.55 +/- 0.31 mmol/l, P < 0.001), insulin (94.0 +/- 0.41 versus 79.5 +/- 5.6 pmol/l, P < 0.01) and HbA(1c) (8.15 +/- 0.24 versus 7.24 +/- 0.19%, P < 0.001).Conclusions Treatment of type 2 diabetic hypertensive patients with rosiglitazone significantly increased insulin sensitivity and lowered ambulatory BP. These changes were strongly correlated. Thiazolidinediones may thus possess a BP-lowering effect beyond their antihyperglycemic properties. (C) 2004 Lippincott Williams Wilkins.