Negro Roberto, Hassan Haslinda
Department of Endocrinology, AUSL LE/1 V.Fazzi, Piazza F. Muratore, Lecce 73100, Italy.
J Renin Angiotensin Aldosterone Syst. 2006 Dec;7(4):243-6. doi: 10.3317/jraas.2006.045.
Hypertension in type 2 diabetes represents a strong risk factor for cardiovascular events. Either calcium channel blockers or angiotensin receptor blockers (ARBs) may reduce insulin resistance. One of the ARBs, telmisartan (Telm) acting as a PPARgamma agonist, significantly reduces HbA(1C) levels. The aim of this study was the comparison of the effects on glycaemic control of amlodipine (Aml) and Telm in hypertensive type 2 diabetic patients.
Forty diabetic hypertensive subjects were assigned to two groups. Group A: rosiglitazone (RSG) 4 mg + Telm 80 mg; Group B: RSG 4 mg + Aml 10 mg. All the patients were already treated with metformin, but not with antihypertensive drugs.
After four months treatment, both groups showed a significant reduction of mean blood pressure (Group A: - 13.5%; Group B: - 13.3%) and a positive influence on glycaemic control and insulin resistance. Lower values of glucose, HbA1C, HOMA index and higher adiponectin levels were observed in Group A compared to Group B. Conclusions. In type 2 diabetic hypertensive patients, the association of Telm 80 mg and RSG 4 mg seems to display a metabolic advantage compared to Aml 10 mg. The simultaneous beneficial effects on blood pressure and insulin sensitivity may confer make Telm particularly suitable in the treatment of the metabolic syndrome.
2型糖尿病中的高血压是心血管事件的一个重要危险因素。钙通道阻滞剂或血管紧张素受体阻滞剂（ARB）均可降低胰岛素抵抗。其中一种ARB，替米沙坦（Telm）作为过氧化物酶体增殖物激活受体γ（PPARγ）激动剂，可显著降低糖化血红蛋白（HbA1C）水平。本研究的目的是比较氨氯地平（Aml）和替米沙坦对2型糖尿病高血压患者血糖控制的影响。
40例糖尿病高血压患者被分为两组。A组：罗格列酮（RSG）4mg + 替米沙坦80mg；B组：RSG 4mg + 氨氯地平10mg。所有患者均已接受二甲双胍治疗，但未使用抗高血压药物。
治疗4个月后，两组患者的平均血压均显著降低（A组：-13.5%；B组：-13.3%），且对血糖控制和胰岛素抵抗产生了积极影响。与B组相比，A组的血糖、糖化血红蛋白、稳态模型评估胰岛素抵抗指数（HOMA指数）值更低，脂联素水平更高。结论：在2型糖尿病高血压患者中，80mg替米沙坦与4mg罗格列酮联合使用似乎比10mg氨氯地平具有代谢优势。对血压和胰岛素敏感性的同时有益作用可能使替米沙坦特别适用于代谢综合征的治疗。
