Imazu Michinori
Division of Internal Medicine, Ajina Tsuchiya Hospital, 4-51-1 Ajina Hatsukaichi, Japan.
Curr Hypertens Rep. 2002 Dec;4(6):477-82. doi: 10.1007/s11906-002-0029-y.
Insulin resistance and/or compensatory hyperinsulinemia are associated with hypertension, obesity, dyslipidemia, and glucose intolerance. Insulin resistance and hyperinsulinemia are considered to increase blood pressure through sympathetic nervous system activation, renin-angiotensin system stimulation, and vascular smooth muscle cell proliferation. Leptin, magnesium ions, nitric oxide, endothelin, peroxisome proliferator-activated receptor gamma, and tumor necrosis factor-alpha also modulate blood pressure. Decreasing insulin resistance by lifestyle modification including diet, weight loss, and physical exercise has been shown to reduce blood pressure. Angiotensin-converting enzyme inhibitors have a beneficial effect on insulin resistance. On the other hand, the angiotensin II antagonist, losartan, does not affect insulin sensitivity. The selective alpha1-blockers have a favorable metabolic profile producing increases in insulin sensitivity. A short-acting type calcium channel blocker seems to decrease insulin sensitivity. On the other hand, long-acting type calcium channel blockers improve insulin sensitivity. Thiazide diuretics and most of the beta-blockers decrease insulin sensitivity. Vasodilatory beta-blockers have been reported to improve insulin sensitivity. Use of low-dose diuretics avoids the adverse effects seen with conventional doses.
胰岛素抵抗和/或代偿性高胰岛素血症与高血压、肥胖、血脂异常和葡萄糖耐量异常相关。胰岛素抵抗和高胰岛素血症被认为通过交感神经系统激活、肾素-血管紧张素系统刺激和血管平滑肌细胞增殖来升高血压。瘦素、镁离子、一氧化氮、内皮素、过氧化物酶体增殖物激活受体γ和肿瘤坏死因子-α也调节血压。通过包括饮食、体重减轻和体育锻炼在内的生活方式改变来降低胰岛素抵抗已被证明可降低血压。血管紧张素转换酶抑制剂对胰岛素抵抗有有益作用。另一方面，血管紧张素II拮抗剂氯沙坦不影响胰岛素敏感性。选择性α1受体阻滞剂具有有利的代谢特征，可提高胰岛素敏感性。短效型钙通道阻滞剂似乎会降低胰岛素敏感性。另一方面，长效型钙通道阻滞剂可改善胰岛素敏感性。噻嗪类利尿剂和大多数β受体阻滞剂会降低胰岛素敏感性。据报道，血管舒张性β受体阻滞剂可改善胰岛素敏感性。使用低剂量利尿剂可避免常规剂量所见的不良反应。
