Lithell H, Pollare T, Vessby B
Department of Geriatrics, Uppsala University, Sweden.
Blood Press. 1992 Aug;1(2):92-101. doi: 10.3109/08037059209077499.
Metabolic effects of pindolol and propranolol were investigated in a randomised study of double-blind, double-dummy design in 39 Caucasians with newly detected hypertension. Each active treatment period was 6 months long. A euglycaemic hyperinsulinaemic clamp test was done to measure insulin sensitivity, and i.v. glucose tolerance was investigated with insulin determinations. Lipoprotein concentrations were quantified and lipoprotein lipase activities were determined in muscle and adipose tissue and in plasma after heparin injection. The blood pressure was significantly reduced by both regimes. The insulin sensitivity index was decreased by 34% during propranolol treatment and by 17% during pindolol treatment. The insulin concentrations in plasma were elevated at the end of the i.v. glucose tolerance test but were not high enough to compensate for the insulin resistance, so HbA1c and glucose concentrations were increased. A significant reduction of lipoprotein lipase activity in skeletal muscle during propranolol treatment probably explains the pronounced increase in serum triglyceride concentration during propranolol treatment despite lower free fatty acids and higher lipoprotein lipase activity in adipose tissue. These changes of lipoprotein lipase activity were not correlated to the changes in insulin sensitivity. In summary, the metabolic effects were significantly less pronounced with pindolol than with propranolol, which probably can be ascribed to the agonistic effect of pindolol on beta 2 adrenoceptors.
在一项针对39名新诊断为高血压的高加索人的随机双盲双模拟设计研究中，对吲哚洛尔和普萘洛尔的代谢效应进行了调查。每个积极治疗期为6个月。进行了正常血糖高胰岛素钳夹试验以测量胰岛素敏感性，并通过胰岛素测定研究静脉内葡萄糖耐量。对脂蛋白浓度进行了定量，并在肝素注射后测定了肌肉、脂肪组织和血浆中的脂蛋白脂肪酶活性。两种治疗方案均使血压显著降低。在普萘洛尔治疗期间，胰岛素敏感性指数降低了34%，在吲哚洛尔治疗期间降低了17%。静脉内葡萄糖耐量试验结束时，血浆胰岛素浓度升高，但不足以补偿胰岛素抵抗，因此糖化血红蛋白和血糖浓度升高。普萘洛尔治疗期间骨骼肌中脂蛋白脂肪酶活性显著降低，这可能解释了尽管脂肪组织中游离脂肪酸含量较低且脂蛋白脂肪酶活性较高，但普萘洛尔治疗期间血清甘油三酯浓度仍显著升高的原因。脂蛋白脂肪酶活性的这些变化与胰岛素敏感性的变化无关。总之，吲哚洛尔的代谢效应明显不如普萘洛尔显著，这可能归因于吲哚洛尔对β2肾上腺素能受体的激动作用。
