Pioglitazone improves left ventricular diastolic function in patients with essential hypertension
Pioglitazone improves left ventricular diastolic function in patients with essential hypertension
复制标题
DOI：
10.1016/j.amjhyper.2005.02.003
复制
发表时间：
2005-07-01
影响因子：
3.2
通讯作者：
Kawano, Y
中科院分区：
文献类型：
--
作者：
Horio, T;Suzuki, M;Kawano, Y
背景：左心室肥厚和舒张功能障碍是高血压常见的心脏后果，可通过胰岛素抵抗改变。本研究评估了胰岛素抵抗的初步治疗可能逆转高血压患者这种心脏变化的假设。方法：30例原发性高血压患者入选本研究。超声心动图检测左室质量指数、早期舒张期与心房充盈峰值速度比（E/A）、E波减速时间（DcT）。采用稳态血浆葡萄糖（SSPG）法进行胰岛素敏感性试验，口服葡萄糖耐量试验，并采血检测脂联素和基质金属蛋白酶(MMP)-2。胰岛素增敏剂吡格列酮（30mg /天）治疗6个月后，重复这些检查。结果：吡格列酮显著提高E/A，降低DcT，左室质量指数无明显变化。在SSPG显著（>= 3.3 mmol/L）降低的受试者（n = 11）中，舒张特性的改善要比其他受试者（n = 19）大得多，尽管血糖水平的降低在两组之间没有差异。此外，E/A和DcT的变化与SSPG的下降密切相关。吡格列酮治疗显著提高血浆脂联素和MMP-2水平，且MMP-2升高与脂联素升高呈正相关。结论：本研究结果表明，吡格列酮可改善高血压患者左室舒张功能，且无左室质量退化，与胰岛素抵抗的改善成正比。这些发现表明，脂联素和MMP的增加可能与吡格列酮对舒张功能的有益作用有关。
Background: Left ventricular (LV) hypertrophy and diastolic dysfunction, which are common cardiac consequences of hypertension, are modified by insulin resistance. The present study assessed the hypothesis that primary treatment of insulin resistance may reverse such cardiac changes in hypertensive patients.Methods: A total of 30 patients with essential hypertension were enrolled in this study. In echocardiographic examinations, LV mass index, the peak velocity ratio of early diastolic to atrial filling (E/A), and the E-wave deceleration time (DcT) were determined. Insulin sensitivity test with steady-state plasma glucose (SSPG) method, oral glucose tolerance test, and blood samplings for measurement of adiponectin and matrix metalloproteinase (MMP)-2 were also performed. Six months after treatment with pioglitazone (30 mg/day), an insulin sensitizer, these examinations were repeated.Results: Pioglitazone significantly increased E/A and decreased DcT, without a change in LV mass index. These improvements in diastolic properties were much greater in subjects with a marked (>= 3.3 mmol/L) decrease in SSPG (n = 11) than the others (n = 19), although the decrease in glucose levels did not differ between the two groups. In addition, the changes in E/A and DcT were closely correlated with the decrease in SSPG. Pioglitazone treatment significantly elevated plasma adiponectin and MMP-2 levels, and the increase in MMP-2 was positively correlated with the increase in adiponectin.Conclusions: The present findings demonstrate that pioglitazone improves LV diastolic function without LV mass regression in hypertensive patients in proportion to the amelioration of insulin resistance. These findings suggest that increased adiponectin and MMP may be involved in the beneficial effect of pioglitazone on diastolic function.