二甲双胍对原发性高血压伴糖耐量减低患者血压的影响

目的:观察二甲双胍单独或与苯那普利联合应用对原发性高血压(EH)患者的降压作用。方法:将120例伴糖耐量减低非糖尿病EH患者随机分为二甲双胍组(59例)和苯那普利组(61例),分别以二甲双胍500mg,3次/d和苯那普利10mg,1次/d治疗。治疗1个月后对收缩压≥140mmHg(1mmHg=0.133kPa)和(或)舒张压≥90mmHg者,给予上述2种药物联合治疗,剂量同上;达标者继续原治疗不变。总疗程为2个月。观察2组治疗前后血压和胰岛素敏感性变化。结果:①与治疗前比较,二甲双胍组和苯那普利组在治疗1个月后收缩压分别下降(12.5±6.4)mmHg和(14.9±6.5)mmHg,舒张压分别下降(8.5±6.2)mmHg和(9.9±3.8)mmHg;在治疗2个月后收缩压分别下降(16.9±5.0)mmHg和(19.9±6.4)mmHg,舒张压分别下降(13.1±5.3)mmHg和(14.3±1.2)mmHg,2组比较均差异无统计学意义(均P>0.05)。2组联合用药率均为56%。②与治疗前比较,空腹胰岛素、糖负荷1h胰岛素、糖负荷2h胰岛素、胰岛素曲线下面积在二甲双胍组于治疗1、2个月后明显下降(均P<0.01);在苯那普利组除糖负荷1h胰岛素于治疗1个月后开始下降外(P<0.05),其余于治疗2个月后明显下降(均P<0.01)。胰岛素敏感性指数在二甲双胍组于治疗1个月后明显高于苯那普利组(P<0.05),在治疗2个月后2组间比较差异无统计学意义(P>0.05)。结论:二甲双胍与苯那普利对伴糖耐量减低EH患者具有相似的降压效应和良好的协同作用。

Effect of metformin on blood pressure in essential hypertensive patients with impaired glucose tolerance

Objective:To observe the antihypertensive effect of metformin alone or in combination with benazepril on patients with essential hypertension(EH).Method:A total of 120 inpatients and outpatients of non-diabetic EH with impaired gucose tolerance(IGT) were recruited and randomly divided into two groups: metformin group of 59 cases treated with metformin 500 mg tid and benazepril group of 61 cases treated with benazepril 10 mg qd.Patients whose systolic blood pressure(SBP) ≥140 mmHg(1 mmHg=0.133 kPa) and(or) diastolic blood pressure(DBP) ≥90 mmHg after 1 month were attained combination therapy with two drugs in the next month.The duration of treatment was 2 months.The changes of blood pressure and insulin sensitivity of the two groups were observed before and after treatment.Result:①After 1 month of treatment,SBP in metformin group and benazepril group decreased by(12.5±6.4)mmHg and(14.9±6.5)mmHg,and DBP decreased by(8.5±6.2)mmHg and(9.9±3.8)mmHg respectively.After 2 months of treatment,SBP in metformin group and benazepril group decreased by(16.9±5.0)mmHg and(19.9±6.4)mmHg,and DBP decreased by(13.1±5.3) mmHg and(14.3±1.2)mmHg respectively.There was no significant differences in decline of the blood pressure between the two groups(P>0.05).The rates of combination therapy were both 56% in the two groups.②Fasting insulin and 60 min insulin levels with 120 min insulin levels after oral glucose tolerance test and insulin area under the curve in the metformin group were significantly reduced after 1 and 2 months of treatment as compared with those before treatment(P<0.01).In the benazepril group,however,they decreased only after 2 months of treatment(P<0.01) except 60 min insulin levels decreased after 1 month of treatment(P<0.05).The insulin action index in the metformin group was higher than that in the benazepril group after 1 month of treatment(P<0.05),but there was no significant difference between the two groups after 2 months of treatment(P>0.05).Conclusion:Metformin and benazepril have similar antihypertensive effect and a good synergy in EH with IGT.