Kirpichnikov Dmitri, Sowers James R
Department of Endocrinology, Diabetes and Hypertension, SUNY Health Science Center at Brooklyn, 450 Clarkson Avenue, Box 1205, Brooklyn, NY 11203, USA.
Curr Diab Rep. 2002 Jun;2(3):251-7. doi: 10.1007/s11892-002-0091-5.
Cardiovascular disease (CVD) is a major determining factor of morbidity and mortality in type 2 diabetic patients. Hypertension, which accompanies diabetes in more than 70% of cases, contributes to increased prevalence of CVD events in this group of patients. Results from the United Kingdom Prospective Diabetes Study (UKPDS) indicated that reduction of elevated blood pressure might decrease CVD morbidity and mortality more than reduction of hyperglycemia. Activation of circulating and tissue renin-angiotensin system (RAS) contributes to the development of both hypertension and insulin resistance in patients with the cardiometabolic syndrome. Angiotensin-converting enzyme (ACE) inhibitor therapy in patients with the cardiometabolic syndrome may improve insulin action as well as lessen CVD. In clinical trials, ACE inhibitors have been shown to be more efficient than other antihypertensive medications (i.e., calcium channel blockers) in the reduction of CVD morbidity and mortality in hypertensive diabetics. In this article, we summarize possible mechanisms by which ACE inhibition may improve insulin resistance, coagulation/clotting, and vascular function abnormalities, and postpone or even prevent the development of type 2 diabetes in hypertensive patients.
心血管疾病（CVD）是2型糖尿病患者发病和死亡的主要决定因素。超过70%的糖尿病患者伴有高血压，这导致该组患者心血管疾病事件的患病率增加。英国前瞻性糖尿病研究（UKPDS）的结果表明，降低血压升高可能比降低高血糖更能降低心血管疾病的发病率和死亡率。循环和组织肾素 - 血管紧张素系统（RAS）的激活促成了心脏代谢综合征患者高血压和胰岛素抵抗的发展。心脏代谢综合征患者使用血管紧张素转换酶（ACE）抑制剂治疗可能改善胰岛素作用并减轻心血管疾病。在临床试验中，已证明ACE抑制剂在降低高血压糖尿病患者心血管疾病发病率和死亡率方面比其他抗高血压药物（即钙通道阻滞剂）更有效。在本文中，我们总结了ACE抑制可能改善胰岛素抵抗、凝血/血栓形成和血管功能异常，并延缓甚至预防高血压患者2型糖尿病发生的可能机制。
