CAJ | 학술논문

目的探讨二甲双胍单独或与福辛普利联合治疗原发性高血压的可能性.方法 140例伴高胰岛素血症的非糖尿病原发性高血压患者被随机分到二甲双胍组(68例)和福辛普利组(72例),分别以二甲双胍500 mg,3次/d和福辛普利10 mg,1次/d治疗,疗程8周.观察两组治疗前后血压、胰岛素敏感性变化.在治疗4周时收缩压(SBP)≥140 mm Hg(1 mm Hg=0.133 kPa)和(或)舒张压(DBP)≥90 min Hg者,给予上述两种药物联合治疗.结果 (1)二甲双胍组和福辛普利组在治疗4周后SBP分别下降(13.0±1.2)mm Hg和(15.4±1.4)mm Hg,DBP分别下降(9.0±1.0)mm Hg和(10.4±1.1)mm Hg;在治疗8周后SBP分别下降(17.8±1.5)mm Hg和(20.9±1.5)mm Hg,DBP分别下降(13.2±0.9)mm Hg和(15.3±1.1)mm Hg,两组比较差异无统计学意义(P>0.05).两组联合用药率均为54%.(2)与基线比较,空腹、糖负荷后0.5、2 h胰岛素、胰岛素曲线下面积在二甲双胍组于治疗4周和8周后明显下降;在福辛普利组于治疗8周后明显下降(P<0.05).胰岛素敏感性指数在二甲双胍组于治疗4周后明显高于福辛普利组(P<0.05),在治疗8周后两组间比较差异无统计学意义(P>0.05).结论在伴高胰岛素血症的原发性高血压人群中,二甲双胍与福辛普利有类似的降压效应和良好的协同作用.
목적 탐토이갑쌍고단독혹여복신보리연합치료원발성고혈압적가능성.방법 140례반고이도소혈증적비당뇨병원발성고혈압환자피수궤분도이갑쌍고조(68례)화복신보리조(72례),분별이이갑쌍고500 mg,3차/d화복신보리10 mg,1차/d치료,료정8주.관찰량조치료전후혈압、이도소민감성변화.재치료4주시수축압(SBP)≥140 mm Hg(1 mm Hg=0.133 kPa)화(혹)서장압(DBP)≥90 min Hg자,급여상술량충약물연합치료.결과 (1)이갑쌍고조화복신보리조재치료4주후SBP분별하강(13.0±1.2)mm Hg화(15.4±1.4)mm Hg,DBP분별하강(9.0±1.0)mm Hg화(10.4±1.1)mm Hg;재치료8주후SBP분별하강(17.8±1.5)mm Hg화(20.9±1.5)mm Hg,DBP분별하강(13.2±0.9)mm Hg화(15.3±1.1)mm Hg,량조비교차이무통계학의의(P>0.05).량조연합용약솔균위54%.(2)여기선비교,공복、당부하후0.5、2 h이도소、이도소곡선하면적재이갑쌍고조우치료4주화8주후명현하강;재복신보리조우치료8주후명현하강(P<0.05).이도소민감성지수재이갑쌍고조우치료4주후명현고우복신보리조(P<0.05),재치료8주후량조간비교차이무통계학의의(P>0.05).결론 재반고이도소혈증적원발성고혈압인군중,이갑쌍고여복신보리유유사적강압효응화량호적협동작용.
Objective To investigate the possibility and utility of metformin alone or in combination with fosinopril to reduce blood pressure in patients with essential hypertension.Met hods A total of 140 cases of non-diabetic essential hypertension with hyperinsulinemia were recruited and randomly assigned to two groups: a group of 68 treated with metformin 500 mg tid and a group of 72 treated with fosinopril 10 mg qd.The duration of the treatment was 8 weeks.Combination therapy with the two drugs was used after 4 weeks of treatment if needed.If the target goals of systolic blood pressure (SBP) < 140 mm Hg (1 mm Hg =0.133 kPa) and /or diastolic blood pressure (DBP) <90 mm Hg were not attained 4 weeks, combination therapy with two drugs was used in either group in the next 4 weeks.The changes of blood pressure and insulin sensitivity of the two groups were observed before and after treatment.Results (1) After 4 weeks of treatment, SBP in metformin group and fosinopril group decreased by ( 13.0 ± 1.2) mm Hg and (15.4 ± 1.4) mm Hg, and DBP decreased by (9.0 ± 1.0) mm Hg and ( 10.4 ± 1.1 ) mm Hg respectively.After 8 weeks of treatment, SBP in metformin group and fosinopril group decreased by (17.8 ± 1.5) mm Hg and (20.9 ± 1.5) mm Hg, and DBP decreased by (13.2 ±0.9) mm Hg and (15.3 ± 1.1) mm Hg respectively.There was no significant difference in the decline of blood pressure between the two groups (P >0.05).The rates of combination therapy were both 54% in the two groups.(2) Fasting insulin as well as 30 min and 120 min insulin levels after oral glucose tolerance test and insulin area under the curve in the metformin group were significantly reduced after 4 and 8 weeks of treatment as compared with those of baseline(P < 0.05 and P < 0.01 ) .In the fosinopril group, however, they decreased only after 8 weeks treatment (P < 0.05).The insulin action index in the metformin group was higher than that in the fosinopril group after 4 weeks of treatment (P <0.05) ,but there was no significant difference between the two groups after 8 weeks of treatment (P > 0.05).Conclusion Metformin and fosinopril have similar antihypertensive effect and a good synergy in essential hypertension with hyperinsulinemia.