高血压病伴代谢综合征患者463例的干预治疗研究

目的　分析高血压病伴代谢综合征人群新发糖尿病的预测因素,同时评价较理想的降压药物以降低危险因素,防止糖尿病发生。方法　用随机平行对照临床试验,选轻、中度高血压病患者符合下列 3项中 2项者进入研究: (1)腰围及(或)体质脂数(BMI)异常; (2)甘油三酯(TG)及(或 )低高密度脂蛋白胆固酯(HDL C)升高; (3)糖耐量异常 (IGT)。将患者分成三个干预治疗组: (1)吲哒帕胺+福辛普利组 (第 1组,n=151); (2)阿替洛尔 +尼群地平组 (第 2组,n=160); (3)阿替洛尔+尼群地平+二甲双胍组(第 3组,n=152)。每月随访 1次,按血压水平调整剂量。每 6个月测定空腹血糖及服 75g葡萄糖 2h后血糖,发现异常者定为新发糖尿病而终止试验。在最后随访时重复测定糖耐量试验(OGTT)、胰岛素释放试验(InRT)、血脂、体重及腰围。结果　(1)在三组降压幅度相似(P>0 05)的基础上,新发糖尿病共 23例,三组分别为 10例, 8例, 5例。虽然加服二甲双胍组比不加组新发人数较少但差异未达统计学意义; (2)从三组危险因素构成比看, 第 2、3组,TG升高者在治疗后,分别下降 14 7%及 9 3% (P<0 05),向心性肥胖分别减少 16 7%及 15 9% (P<0 05 ),IGT分别减少 6 6%及 29 6% (P<0 05),而第 1组服药后均无明显变化; (3)平均随访 1年 5个月后基础状态危险因素 (

A clinical intervention study among 463 essential hypertensive patients with metabolic syndrome

OBJECTIVE: To study the role of baseline risk factors in predicting the onset of diabetes among essential hypertensive patients with metabolic syndrome (MS) and to evaluate an ideal therapeutic regime that could reduce the risk factors and risk of onset of diabetes. METHODS: A randomized parallel clinical trial in essential hypertensive patients of grade 1 or 2 was conducted. Two of the three components (1) increased waist circumference and/or BMI; (2) increased triglycerides (TG) and/or decreased high-density lipoprotein cholesterol; (3) impaired glucose tolerance (IGT) were present define the MS. The three intervention therapy groups were: imdapamide + fosinopril (I + F, n = 151); atenolol + nitredipine (A + N, n = 160); atenolol + nitredipine + metformin (A + N + M, n = 152). Each case was followed-up monthly and the dosage of medicine taken be adjusted according to their BP level. The plasma glucose during fasting and two hours after taking 75 g glucose orally was also measured every six months. The new onset of diabetes was diagnosed according to the criteria. OGTT, insulin release test, lipid analysis, body weight and waist circumference were measured again at the last follow-up. RESULTS: (1) The lowering of BP was similar among the three groups (P > 0.05). 23 new diabetes onsets occurred, being 10 in group I + F and 8 in group A + N and 5 in group A + N + M, respectively (P > 0.05); (2) Proportions of patients' risk factors decreased significantly in group A + N or A + N + M, e.g. the proportions of high TG in each group reduced by 14.7% and 9.3% respectively (P < 0.05), the central fat distribution reduced by 16.7% and 15.9% respectively (P < 0.05) and the IGT reduced by 6.6% and 29.6% respectively (P < 0.05). However no changes were found in group I + F; (3) After 1 year and 5 months' follow-up, the proportions of main risk factors (high TG, central fat distribution and IGT) in the three groups were 91%, 96%, 83% and 90%, 88%, 47%, respectively. The difference of IGT was significant between two groups (P < 0.01) and the proportions of having three risk factors were 70% and 31% in the two groups (P < 0.01); (4) I + F group was better than A + N group in reduction of TG and central fat distribution. And A + N + M group improved in all risk factors. CONCLUSIONS: IGT alone or combined with increased TG plus abdominal obesity are the most important risk factors in predicting a new onset of diabetes among essential hypertensive patients with MS. Metformin in combination with atenolol plus nitredipine can significantly prevent the onset of diabetes as well as improve patients' metabolic abnormality.