原发性高血压胰岛素抵抗与心率变异性的关系及临床干预治疗

目的探讨原发性高血压伴胰岛素抵抗与心率变异性的关系及临床干预后的变化.方法原发性高血压胰岛素抵抗患者60例为胰岛素抵抗组,非胰岛素抵抗患者30例为非胰岛素抵抗组,正常对照30例为正常对照组,行心率变异比较后将胰岛素抵抗组患者随机分成胰岛素抵抗A、B2组各30例,胰岛素抵抗A组给予钙离子拮抗剂,胰岛素抵抗B组给予血管紧张素转换酶抑制剂分别治疗4周.结果药物治疗前胰岛素抵抗组与非胰岛素抵抗组和正常对照组心率变异各项指标比较有显著性差异(P＜0.01).治疗后胰岛素抵抗A组胰岛素水平及心率变异指标改善不显著;胰岛素抵抗B组胰岛素水平及心率变异指标明显改善,2组间比较有显著性差异(P＜0.01).结论血管紧张素转换酶抑制剂贝那普利较好地改善了血胰岛素水平及心率变异各项指标,其效果优于钙离子拮抗剂硝苯地平.

Relationship between Insulin Resistance and Heart Rate Variability in Patientswith Hypertension and Clinical Interventional Treatment

Objective:To evaluate the relationship between insulin resistance and heart rate variability (HRV)in patients with hypertension. Methods: We studied 60 patients with hypertension accompanied by insulin resistance and 30 patients without insulin resistance. Thirty normal subjects served as controls. Sixty patients with hypertension accompanied by insulin resistance were randomized into two groups. Calcium channel blocker(CCB,group A,n=30) and angiotensin converting enzyme inhibitor (ACEI,group B,n=30)were administered for 4 weeks respectively. Results :Before treatment the parameters of HRV in hypertensive patients with insulin resistance were significant different (p<0. 01,respectively)compared with those in the patients without insulin resistance and normal subjects. The level of insulin and parameters of HRV were not improved significanty in group A after administration of CCB, but significant in group B(P<0.01). The differences between groups A and B were significant (p<0. 01). Conclusion: ACEI agent can improve the level of blood insulin and the parameters of HRV. It is very different compared with CCB agent.