Prichard B N, Smith C C, Sen S, Betteridge D J
Division of Clinical Pharmacology, University College London, England.
J Cardiovasc Pharmacol. 1992;20 Suppl 11:S77-84.
Insulin resistance and hyperinsulinemia is now recognized in non-insulin-dependent diabetes, essential hypertension, obesity, atherosclerotic heart disease, dyslipidemia, heart failure, and in heavy smokers. Several mechanisms have been proposed to explain hyperinsulinemia, insulin resistance and its relationship to hypertension; reduced sodium excretion, activation of the sympathetic nervous system, increased activity of the sodium/hydrogen pump, and stimulation of cellular growth. Some of the nonpharmacological methods to control hyperinsulinemia are of benefit in the management of hypertension, most notably weight loss, exercise program, and reduced salt intake. High-fiber and reduced-protein diets also reduce hyperinsulinemia. Thiazide diuretics can result in insulin resistance, and insulin secretion may be inhibited, possibly associated with concomitant hypokalemia. beta-Blockers result in some reduction of glucose tolerance and mask some of the features of hypoglycemia. Angiotensin-converting enzyme (ACE) inhibitors and alpha-receptor blockers do not effect insulin resistance; probably the same is true for calcium antagonists. Although the effect on risk factors should not be discounted, it is the effect of treatment on hard end points, cerebrovascular accidents, myocardial infarction, or death that is most important. Evidence in hypertension is at present restricted to diuretics and beta-blocking drugs.
胰岛素抵抗和高胰岛素血症目前在非胰岛素依赖型糖尿病、原发性高血压、肥胖症、动脉粥样硬化性心脏病、血脂异常、心力衰竭以及重度吸烟者中均有发现。已经提出了几种机制来解释高胰岛素血症、胰岛素抵抗及其与高血压的关系；钠排泄减少、交感神经系统激活、钠/氢泵活性增加以及细胞生长受刺激。一些控制高胰岛素血症的非药物方法对高血压的管理有益，最显著的是体重减轻、运动计划和减少盐摄入。高纤维和低蛋白饮食也可降低高胰岛素血症。噻嗪类利尿剂可导致胰岛素抵抗，并且可能抑制胰岛素分泌，这可能与伴随的低钾血症有关。β受体阻滞剂会导致葡萄糖耐量有所降低，并掩盖低血糖的一些特征。血管紧张素转换酶（ACE）抑制剂和α受体阻滞剂不会影响胰岛素抵抗；钙拮抗剂可能也是如此。尽管对危险因素的影响不容忽视，但治疗对硬性终点、脑血管意外、心肌梗死或死亡的影响才是最重要的。目前高血压方面的证据仅限于利尿剂和β受体阻滞剂药物。
