Sarafidis Panteleimon A, Lasaridis Anastasios N
1st Department of Medicine, AHEPA University Hospital, Aristotle University, St. Kiriakidi 1, 54006 Thessaloniki, Greece.
Am J Hypertens. 2006 Jun;19(6):646-53. doi: 10.1016/j.amjhyper.2005.12.017.
The metabolic syndrome is a cluster of disturbances such as type 2 diabetes mellitus, hypertension, central obesity, dyslipidemia, and others for which insulin resistance and compensatory hyperinsulinemia have been proposed to be the underlying disorders. Several possible mechanisms linking insulin resistance and compensatory hyperinsulinemia with hypertension have been described, such as renal sodium reabsorption enhancement, sympathetic nervous system activation, and blunted insulin-mediated vasodilation caused by endothelial dysfunction. Peroxisome proliferator-activated receptors-gamma agonists or thiazolidinediones (TZD) are a class of agents for the treatment of type 2 diabetes mellitus that act through improvement of insulin sensitivity. In parallel to their antihyperglycemic action, these drugs were found to exert beneficial effects on other components of the metabolic syndrome. For example all TZD have been shown to reduce blood pressure (BP) levels in both animal and human studies. In addition a considerable number of in vitro and in vivo studies report actions of TZD on the cardiovascular system that could explain this blood pressure-lowering effect of TZD, such as restoration of blunted endothelium-mediated vasodilation, attenuation of sympathetic overactivity, inhibition of intracellular Ca(2+) increase, and proliferation of vascular smooth muscle cells and others. This review summarizes the current evidence about these actions of TZD that could positively influence BP, representing possible mechanisms of BP amelioration.
代谢综合征是一组紊乱症状，如2型糖尿病、高血压、中心性肥胖、血脂异常等，胰岛素抵抗和代偿性高胰岛素血症被认为是这些症状的潜在病因。已经描述了几种将胰岛素抵抗和代偿性高胰岛素血症与高血压联系起来的可能机制，如肾钠重吸收增强、交感神经系统激活以及由内皮功能障碍导致的胰岛素介导的血管舒张减弱。过氧化物酶体增殖物激活受体γ激动剂或噻唑烷二酮类药物（TZD）是一类通过改善胰岛素敏感性来治疗2型糖尿病的药物。在发挥降糖作用的同时，发现这些药物对代谢综合征的其他组分也有有益作用。例如，在动物和人体研究中均显示，所有TZD均可降低血压水平。此外，大量的体外和体内研究报道了TZD对心血管系统的作用，这些作用可以解释TZD的这种降压效果，如恢复减弱的内皮介导的血管舒张、减轻交感神经过度活动、抑制细胞内Ca(2+)升高以及血管平滑肌细胞增殖等。本综述总结了目前关于TZD这些可能对血压产生积极影响的作用的证据，阐述了血压改善的可能机制。
