LONG-TERM METABOLIC EFFECTS OF ANTIHYPERTENSIVE DRUGS
LONG-TERM METABOLIC EFFECTS OF ANTIHYPERTENSIVE DRUGS
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DOI：
10.1016/0002-8703(94)90749-8
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发表时间：
1994-12-01
影响因子：
4.8
通讯作者：
LITHELL, H
中科院分区：
文献类型：
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作者：
LIND, L;POLLARE, T;LITHELL, H
在短期研究（4至6个月）中，我们报道了使用S-肾上腺素能阻滞剂和噻嗪类利尿剂进行抗高血压治疗会导致胰岛素抵抗、高胰岛素血症和血脂紊乱； ACE抑制剂卡托普利增加胰岛素敏感性而不影响血脂。在本研究中，最初纳入短期研究的149名原发性高血压患者中的65名在治疗2至3年后重新检查。高胰岛素正常血糖钳夹法显示，吲哚洛尔、普萘洛尔、美托洛尔、阿替洛尔或氢氯噻嗪治疗4至6个月后引起的胰岛素敏感性显着降低（p < 0.01）在治疗2至3年后仍持续存在。此外，卡托普利 6 个月后报告的胰岛素敏感性增加 (p < 0.05) 在长期治疗期间没有显着改变。此外，大多数无内在拟交感神经活性的β-肾上腺素能阻断剂和氢氯噻嗪诱导的极低密度脂蛋白甘油三酯水平升高（p < 0.01）和高密度脂蛋白胆固醇水平降低（p < 0.01）持续存在。另一方面，卡托普利在长期治疗期间并没有显着影响血脂。总之，短期研究中抗高血压治疗引起的代谢效应与2至3年长期治疗后的代谢效应程度相同，与短期研究结果没有显着差异。
In short-term studies (4 to 6 months) we have reported that antihypertensive treatment with S-adrenergic blockade and thiazide diuretics induced insulin resistance, hyperinsulinemia, and a deranged lipid profile; the ACE inhibitor captopril increased insulin sensitivity without affecting serum lipids. In the present study, 65 of the original 149 patients with essential hypertension included in the short-term studies were reexamined after treatment for 2 to 3 years. The hyperinsulinemic euglycemic clamp method showed that the significant decrease in insulin sensitivity (p < 0.01) induced by treatment with pindolol, propanolol, metoprolol, atenolol, or hydrochlorothiazide after 4 to 6 months persisted after 2 to 3 years of treatment. Furthermore, the increase in insulin sensitivity reported for captopril after 6 months (p < 0.05) was not significantly altered during long-term treatment. Also, the raised levels of very low-density lipoprotein triglycerides (p < 0.01) and reduced levels of high-density lipoprotein cholesterol (p < 0.01) induced by most of the beta-adrenergic blockade without intrinsic sympathomimetic activity and hydrochlorothiazide persisted. Captopril, on the other hand, did not significantly affect the lipids during prolonged treatment. In conclusion, the magnitude pf the metabolic effects induced by antihypertensive treatment during short-term studies was of the same order after long-term treatment over 2 to 3 years and were not significantly different from the results in the short-term studies.