肥胖对高血压患者降压药治疗后血糖和血脂变化的影响

目的 研究肥胖对高血压患者抗高血压药治疗后血糖和血脂变化的影响。方法 138例轻中度高血压患者被随机分为3组，分别为复方降压片治疗组(第1组)、福辛普利和吲达帕胺联合治疗组(第2组)、尼群地平和阿替洛尔联合治疗组(第3组)，根据我国肥胖标准每组分为肥胖亚组和非肥胖亚组。疗程14个月。观察血糖、血脂的变化。结果 第1组患者治疗后两亚组血糖均显著下降，血脂无显著变化。第2组患者治疗后肥胖亚组血糖显著升高，高密度脂蛋白／低密度脂蛋白比值显著下降，非肥胖亚组血糖和血脂无变化。第3组患者治疗后肥胖亚组血糖显著升高，高密度脂蛋白／低密度脂蛋白比值显著下降；非肥胖亚组空腹血糖显著升高，血脂无显著变化。结论 复方降压片能改善不同肥胖度高血压患者的糖代谢，福辛普利和吲达帕胺联合应用与尼群地平和阿替洛尔联合治疗均不利于肥胖高血压患者的血糖和血脂代谢，且福辛普利和吲达帕胺联合治疗对其影响更大。

Effect of obesity on change in blood glucose and blood lipid after treatment with different combinations of antihypertension drugs in patients with essential hypertension

Objective To investigate the effect of obesity on change of the levels of blood glucose and blood lipid after treatment with different combinations of antihypertensive drugs in patients with essential hypertension (EH). Methods One hundred and thirty-eight patients with mild to moderate EH were randomly divided into 3 groups with different combinations of drugs: reserpine with dihydralazine, hydrochlorothiazide, potassium chloride group (group 1), fosinopril with indapamide group (group 2), and nifedipine with atenolol group (group 3). Treatment period lasted for 14 months. Every group was divided into obesity subgroup and non-obesity subgroup according to Chinese obesity standard. Results After treatment, blood glucose levels were significantly decreased and blood lipid level was unchanged in both obesity subgroup and non-obesity subgroup of group 1. High density lipoprotein-cholesterol (HDL-C)/low density lipoprotein-cholesterol (LDL-C) ratio was significantly decreased and blood glucose was significantly increased in obesity subgroup, however, there was not significant change in the level of blood glucose and blood lipid in non-obesity subgroup of group 2. Blood glucose level was significantly increased and HDL-C/LDL-C ratio was significantly decreased in obesity subgroup, however, there was significant increase only in fasting blood glucose in non-obesity subgroup of group 3. Conclusions The results suggested that treatment with a combination of reserpine and dihydralazine, hydrochlorothiazide, potassium chloride showed beneficial effect on improving carbohydrate metabolism in both obese and non-obese patients with EH, while the treatment with the combination of fosinopril with indapamide deteriorated carbohydrate and lipid metabolism in obese patients with EH, and the treatment with combination of nifedipine with atenolol impaired carbohydrate and lipid metabolism in obese patients with EH.