缬沙坦与卡托普利改善高血压胰岛素抵抗的比较研究

目的：观察缬沙坦（代文）及卡托普利（开博通）对高血压胰岛素抵抗（ISR）的影响。方法：将54例伴有空腹胰岛素增高的轻中度高血压病患者随机分为两组。缬沙坦治疗组（V组）：26例，每日服缬沙坦1次，80－160mg；卡托普利治疗组（C组）：28例，每日服卡托普利2次，每欠25－50mg。疗程为3个月。测定治疗前后血压、空腹及餐后2h血糖和胰岛素，计算胰岛素敏感指数（ISI），治疗前后比较，并设正常对照组，进行组间比较。结果：两组降压作用相似，治疗前各组空腹血糖无显著差异，两组餐后2h血糖、空腹及餐后2h胰岛素显著升高（P＜0.01)，ISI显著降低（P＜0.01)，治疗后以上指标显著改善（P＜0.05)，但均未达正常（P＜0.05)。结论：缬沙坦和卡托普利都能改善高血压胰岛 素抵抗，但短期治疗不能使胰岛素敏感性恢复正常。

Comparison of effects of Yalsartan and Captopril on insulin resistance in essential hypertension

To compare the effects of valsartan and captopril on insulin resistance in essential hypertension. Methods: 54 mild to moderate hypertensive patients with fasting hyperinsulinemia were randomly assigned into two groups receiving either valsartan (Group V; Diovan 80-160mg qd, n =26) or captopril (Group C: Captopril 25-50mg bid, n =28) for 3 months. Blood pressure, serum concentration of fasting insulin (FINS) and glucose (FGLU), 2 hour postprandial blood gluscose and serum insulin (2hGLU and 2hINS) were measured respectively on the first and last day of treatment. 20 healthy subjects were served as a normal controlled group (Group N). Insulin-sensitivity index (ISI) was calculated to evaluate the change of ISR after treatment. ISI was also used to compare the differences of ISR among Group V, Group C and Group N. Results: There was similar efficacy in decreasing blood pressure for valsartan and captopril. There were no significant differences of FGLU among all groups before treatment. In both Group V and Group C 2hGLU, FINS and 2hINS all significantly increased while ISI significantly decreased (P<0.01). These parameters all significantly improved after treatment (P<0.05), but still did not reach normal level (P <0.05). Conclusions; Both valsartan and captopril can improve insulin sensitivity in essential hypertension. But they can not restore it to the normal level with short-term treatment.