Shimabukuro Michio, Tanaka Hideaki, Shimabukuro Takeshi
Second Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus, Okinawa and Diabetes and Life-style Related Disease Center, Tomishiro Chuo Hospital, Okinawa, Japan.
J Hypertens. 2007 Apr;25(4):841-8. doi: 10.1097/HJH.0b013e3280287a83.
Visceral fat obesity plays an essential role in the clustering of atherosclerotic multiple risk factors in the metabolic syndrome. Telmisartan, an angiotensin II type 1 receptor blocker, has partial agonistic properties for peroxisome proliferator-activated receptor gamma, which is a key regulator of adipocyte differentiation and function.
This study aimed to clarify the impact of telmisartan on fat distribution and insulin sensitivity in the metabolic syndrome. In this open-label, prospective, randomized study, patients with the metabolic syndrome (waist circumference: men >or= 85 cm, women >or= 90 cm) were treated either with amlodipine (n = 26) or with telmisartan (n = 27) for 24 weeks, and fat distribution and insulin sensitivity were determined.
Systolic and diastolic blood pressure were decreased in both groups to a comparable level. However, insulin and glucose levels during an oral 75 g glucose loading were decreased only in the telmisartan group. The visceral fat area, determined by abdominal computed tomography scan, was reduced in the telmisartan group after 24 weeks' treatment, but the subcutaneous fat area did not change in either group.
The results imply that telmisartan could treat both the hemodynamic and metabolic aberrations seen in patients with the metabolic syndrome, improving insulin resistance and glucose intolerance at least partly through visceral fat remodeling.
内脏脂肪肥胖在代谢综合征中动脉粥样硬化多种危险因素的聚集过程中起重要作用。替米沙坦是一种血管紧张素II 1型受体阻滞剂，对过氧化物酶体增殖物激活受体γ具有部分激动特性，而过氧化物酶体增殖物激活受体γ是脂肪细胞分化和功能的关键调节因子。
本研究旨在阐明替米沙坦对代谢综合征患者脂肪分布和胰岛素敏感性的影响。在这项开放标签、前瞻性、随机研究中，对代谢综合征患者（腰围：男性≥85 cm，女性≥90 cm）分别给予氨氯地平（n = 26）或替米沙坦（n = 27）治疗24周，并测定脂肪分布和胰岛素敏感性。
两组的收缩压和舒张压均降至相当水平。然而，仅替米沙坦组口服75 g葡萄糖负荷期间的胰岛素和血糖水平降低。经腹部计算机断层扫描测定，替米沙坦组治疗24周后内脏脂肪面积减小，但两组的皮下脂肪面积均未改变。
结果表明，替米沙坦可治疗代谢综合征患者出现的血流动力学和代谢异常，至少部分通过内脏脂肪重塑改善胰岛素抵抗和葡萄糖不耐受。
