Hanon O, Giacomino A, Troy S, Bernaud C, Girerd X, Weber S
Service de médecine interne, hôpital Broussais, 96, rue Didot, 75014 Paris, France.
Ann Cardiol Angeiol (Paris). 2000 Oct;49(7):390-6.
The treatment of hypertension represents one of the major elements of the cardiovascular prognosis in type II diabetes. Among antihypertensive drugs, alpha blockers may be interesting because of the absence of unfavourable effects on plasma glucose and lipid levels.
The aim of this study was to evaluate the effectiveness and the safety of prazosin osmotic tablet treatment in non-insulin-dependent diabetic patients with mild to moderate arterial hypertension.
After an initial 4-week-single-blind placebo period, 81 hypertensive subjects (162 +/- 11/96 +/- 5 mmHg) with type II diabetes were included in the study to receive prazosin osmotic tablet (o.t) open-label therapy at the dose of 2.5 mg/day for 12 weeks. After 4 weeks of treatment the dosage of prazosin o.t was increased to 5 mg/day if the diastolic blood pressure remained > or = 90 mmHg.
Both supine and standing systolic and diastolic blood pressures were significantly decreased (P < 0.001) with prazosin therapy from 162 +/- 10/96 +/- 5 mmHg in supine and 160 +/- 12/95 +/- 6 mmHg in the upright position, to 149 +/- 15/86 +/- 9 mmHg and 148 +/- 16/86 +/- 9 mmHg respectively at the end of the 12-week-treatment period. There were no significant changes in the glycemic parameters (glycemia, haemoglobin A1c) during the prazosin therapy compared with baseline values. A significant decrease of triglycerides (P = 0.005), total cholesterol (P < 0.001) and LDL cholesterol (P = 0.03) levels was observed during prazosin therapy compared with the baseline measurements, whereas HDL cholesterol remained stable. Only 6% of the patients reported adverse events in relation with the study drug during the active treatment period.
This study showed a significant decrease of the blood pressure in hypertensive subjects with type II diabetes after prazosin o.t treatment, without any change of glycemic parameters. Moreover, there was a favourable evolution of the lipidic parameters during the study characterised by a significant decrease of triglycerides and total and LDL cholesterol.
高血压的治疗是II型糖尿病心血管预后的主要因素之一。在抗高血压药物中，α受体阻滞剂可能很有意义，因为它对血糖和血脂水平没有不良影响。
本研究的目的是评估哌唑嗪渗透片治疗非胰岛素依赖型糖尿病合并轻度至中度动脉高血压患者的有效性和安全性。
在最初为期4周的单盲安慰剂期后，81名患有II型糖尿病的高血压受试者（收缩压162±11/舒张压96±5 mmHg）被纳入研究，接受剂量为2.5 mg/天的哌唑嗪渗透片开放标签治疗，为期12周。治疗4周后，如果舒张压仍≥90 mmHg，则将哌唑嗪渗透片的剂量增加至5 mg/天。
哌唑嗪治疗后，仰卧位和站立位的收缩压和舒张压均显著降低（P<0.001），仰卧位从162±10/96±5 mmHg降至149±15/86±9 mmHg，站立位从160±12/95±6 mmHg降至148±16/86±9 mmHg。与基线值相比，哌唑嗪治疗期间血糖参数（血糖、糖化血红蛋白）无显著变化。与基线测量值相比，哌唑嗪治疗期间甘油三酯（P = 0.005）、总胆固醇（P<0.001）和低密度脂蛋白胆固醇（P = 0.03）水平显著降低，而高密度脂蛋白胆固醇保持稳定。在积极治疗期间，只有6%的患者报告了与研究药物相关的不良事件。
本研究表明，II型糖尿病高血压患者接受哌唑嗪渗透片治疗后血压显著降低，血糖参数无任何变化。此外，在研究期间血脂参数有良好变化，其特征是甘油三酯、总胆固醇和低密度脂蛋白胆固醇显著降低。
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