白大衣高血压中胰岛素抵抗与靶器官损害的关系。

Relationship between insulin resistance and end-organ damage in white coat hypertension.

作者信息

Tunçkale Aydin, Aran Sinan N, Karpuz Hakan, Dirican Ahmet

机构信息

Department of Internal Medicine, Division of General Internal Medicine, Istanbul University, Cerrahpaşa Medical School, Istanbul, Turkey.

出版信息

Am J Hypertens. 2004 Nov;17(11 Pt 1):1011-6. doi: 10.1016/j.amjhyper.2004.07.002.

DOI:10.1016/j.amjhyper.2004.07.002

PMID:15533726

Abstract

BACKGROUND

End-organ damage is seen in some patients suffering from white coat hypertension (WCH). It remains unclear which patients elude the risk of end-organ damage. A relationship between end-organ damage and insulin resistance was hypothesized.

METHODS

This hypothesis was tested by comparing two groups of patients with WCH: those presenting with end-organ damage and those without end-organ damage. Both groups were tested for the presence of insulin resistance. The study was conducted in the outpatient clinics of the Internal and Family Medicine Departments of Cerrahpasa Medical School, Istanbul University. In this study 290 patients were screened for WCH, of which 75 were included in the study. The WCH was defined as an office blood pressure (BP) >/=140/90 mm Hg and mean daytime BP <135/85 mm Hg. The patients were divided into two groups according to the presence of end-organ damage. All patients received 24-h ambulatory BP monitoring. End-organ damage was diagnosed by revealing left ventricular hypertrophy on echocardiographic examination or retinopathy with fundoscopic examination. The homeostasis model assessment insulin resistance index (HOMA-IR) was used to assess insulin resistance.

RESULTS

Among 75 patients with WCH, hypertensive retinopathy was detected in 25 patients, left ventricular hypertrophy in 15 patients, and both retinopathy and left ventricular hypertrophy simultanously in 6 patients. There were no significant differences between the groups regarding age, sex, lipid profile, and glucose levels. The HOMA-IR values in the patients with WCH and end-organ damage (4.2 +/- 1.7) were significantly higher (P < .0001) than those determined in patients with WCH but without end-organ damage (2.6 +/- 1.8). In patients with WCH with HOMA-IR values above 3 the risk of end-organ damage was found to be higher.

CONCLUSIONS

A possible relationship between end-organ damage and insulin resistance in patients with WCH exists.

摘要

背景

在一些白大衣高血压（WCH）患者中可见靶器官损害。目前尚不清楚哪些患者可避免靶器官损害风险。有人提出靶器官损害与胰岛素抵抗之间存在关联。

方法

通过比较两组WCH患者来验证这一假设：有靶器官损害的患者和无靶器官损害的患者。对两组患者均进行胰岛素抵抗检测。该研究在伊斯坦布尔大学Cerrahpasa医学院内科和家庭医学科门诊进行。本研究筛查了290例WCH患者，其中75例纳入研究。WCH定义为诊室血压（BP）≥140/90 mmHg且日间平均血压<135/85 mmHg。根据是否存在靶器官损害将患者分为两组。所有患者均接受24小时动态血压监测。通过超声心动图检查发现左心室肥厚或眼底镜检查发现视网膜病变来诊断靶器官损害。采用稳态模型评估胰岛素抵抗指数（HOMA-IR）来评估胰岛素抵抗。

结果

75例WCH患者中，25例检测出高血压视网膜病变，15例检测出左心室肥厚，6例同时存在视网膜病变和左心室肥厚。两组在年龄、性别、血脂谱和血糖水平方面无显著差异。有靶器官损害的WCH患者的HOMA-IR值（4.2±1.7）显著高于无靶器官损害的WCH患者（2.6±1.8）（P<.0001）。在HOMA-IR值高于3的WCH患者中，发现靶器官损害风险更高。