Stump Craig S, Hamilton Marc T, Sowers James R
Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Missouri-Columbia, Harry S Truman VA Medical Center, Columbia, MO 65212, USA.
Mayo Clin Proc. 2006 Jun;81(6):796-806. doi: 10.4065/81.6.796.
People with hypertension have a high prevalence of insulin resistance and are at relatively high risk of developing type 2 diabetes mellitus. It is becoming increasingly evident that antihypertensive agents have disparate metabolic effects. For example, recent clinical trials indicate that agents that interrupt the renin-angiotensin axis reduce the risk of developing diabetes compared with other classes of antihypertensive agents. Blockade of the effects of angiotensin II might improve blood flow to insulin-sensitive tissues. Furthermore, interruption of the renin-angiotensin system might provide metabolic benefit through such mechanisms as reduced oxidative stress and restored nitric oxide production, which could lead to improved insulin signaling. Alternatively, collective trials suggest that both diuretics and beta-blockers accelerate the appearance of new-onset type 2 diabetes mellitus in patients with hypertension. Therefore, the risk of new-onset diabetes-associated cardiovascular risks should be factored into future treatment recommendations for patients who require antihypertensive therapy. This will become even more important as the number of insulin-resistant patients with hypertension increases in parallel with the steady growth in the number of sedentary, obese, and aged persons in our population.
高血压患者胰岛素抵抗的患病率较高，患2型糖尿病的风险也相对较高。越来越明显的是，抗高血压药物具有不同的代谢效应。例如，最近的临床试验表明，与其他类别的抗高血压药物相比，阻断肾素-血管紧张素轴的药物可降低患糖尿病的风险。阻断血管紧张素II的作用可能会改善胰岛素敏感组织的血流。此外，中断肾素-血管紧张素系统可能通过减少氧化应激和恢复一氧化氮生成等机制提供代谢益处，这可能会改善胰岛素信号传导。另外，多项试验表明，利尿剂和β受体阻滞剂都会加速高血压患者新发2型糖尿病的出现。因此，对于需要抗高血压治疗的患者，新发糖尿病相关心血管风险应纳入未来的治疗建议中。随着高血压胰岛素抵抗患者数量的增加，这一点将变得更加重要，而这与我们人群中久坐不动、肥胖和老年人数的稳步增长同步。
