Füllert S, Schneider F, Haak E, Rau H, Badenhoop K, Lübben G, Usadel K-H, Konrad T
Medical Department I, J. W. Goethe University, Frankfurt, Germany.
J Clin Endocrinol Metab. 2002 Dec;87(12):5503-6. doi: 10.1210/jc.2002-020963.
Hypertension is often associated with insulin resistance, dyslipidemia and obesity, which indicate a prediabetic state and increased risk of cardiovascular disease. Pioglitazone treatment of patients with type 2 diabetes reduces insulin resistance and improves lipid profiles. The present double-blind placebo-controlled study is the first study to report effects of pioglitazone in non-diabetic patients with arterial hypertension. Following a one week run-in, 60 patients were randomized to receive either pioglitazone (45 mg/day) or placebo for 16 weeks. Insulin sensitivity (M-value) increased by 1.2 +/- 1.7 mg/min/kg with pioglitazone compared with 0.4 +/- 1.4 mg/min/kg (P = 0.022) with placebo. HOMA index was decreased (-22.5 +/- 45.8) by pioglitazone but not by placebo (+0.8 +/- 26.5; P < 0.001). Decreases in fasting insulin and glucose were significantly (P = 0.002 and P = 0.004, respectively) greater with pioglitazone than placebo. Body weight did not change significantly with either treatment. HDL-cholesterol was increased and apolipoprotein B was decreased to a significantly greater extent with pioglitazone. There was a significantly (P = 0.016) greater decrease from baseline in diastolic blood pressure with pioglitazone. These changes would suggest improved glucose metabolism and a possible reduction in risk of cardiovascular disease with pioglitazone treatment of non-diabetic patients with arterial hypertension.
高血压常与胰岛素抵抗、血脂异常和肥胖相关，这些表明处于糖尿病前期状态且心血管疾病风险增加。吡格列酮治疗2型糖尿病患者可降低胰岛素抵抗并改善血脂状况。本双盲安慰剂对照研究是首个报告吡格列酮对非糖尿病性动脉高血压患者疗效的研究。经过1周的导入期后，60例患者被随机分为接受吡格列酮（45毫克/天）或安慰剂治疗16周。与安慰剂组的0.4±1.4毫克/分钟/千克（P = 0.022）相比，吡格列酮组的胰岛素敏感性（M值）增加了1.2±1.7毫克/分钟/千克。吡格列酮使HOMA指数降低了（-22.5±45.8），而安慰剂组未降低（+0.8±26.5；P < 0.001）。吡格列酮组空腹胰岛素和血糖的降低幅度分别显著大于安慰剂组（P分别为0.002和0.004）。两种治疗方法对体重均无显著影响。吡格列酮组高密度脂蛋白胆固醇升高，载脂蛋白B降低幅度更大。吡格列酮组舒张压较基线的降低幅度显著更大（P = 0.016）。这些变化表明，吡格列酮治疗非糖尿病性动脉高血压患者可改善葡萄糖代谢，并可能降低心血管疾病风险。
