Grandi Anna M, Laurita Emanuela, Marchesi Chiara, Maresca Andrea, Solbiati Francesco, Nicolini Eleonora, Gianni Monica, Guasti Luigina, Venco Achille
Department of Clinical Medicine, University of Insubria, Varese, Italy.
Am J Hypertens. 2007 Apr;20(4):410-5. doi: 10.1016/j.amjhyper.2006.09.023.
Genetic factors play an important role in linking insulin resistance and hypertension, also influencing insulin sensitivity changes during antihypertensive treatment. This study was aimed to evaluate whether genetic predisposition to hypertension can also influence left ventricular (LV) changes during antihypertensive treatment.
We enrolled 36 never-treated hypertensives: 18 with both parents hypertensive (F+) and 18 with both parents normotensive (F-), matched for age, gender, and body mass index (BMI). The patients were evaluated twice, before and after 2.5 years of treatment with enalapril. At both evaluations the patients underwent: 24-h blood pressure (BP) monitoring, LV echocardiogram, and oral glucose tolerance test, with measurements of glucose and insulin levels.
At basal evaluation the two groups were not different with regard to gender, age, BMI, 24-h BP, and fasting glucose; glucose metabolic clearance rate was significantly lower in F+. The LV mass index was similar between the groups, whereas diastolic parameters were significantly lower in F+. At second evaluation, 24-h BP and LV mass were decreased to the same extent in both groups; glucose metabolic clearance rate significantly increased in F- and remained unchanged in F+. The improvement of LV diastolic function, found in both group, was significantly greater in F-.
Genetic predisposition to hypertension, in addition to affecting insulin sensitivity, influences LV functional changes during antihypertensive treatment. Despite a similar extent of 24-h BP and LV mass decrease, F+ patients showed no changes in insulin sensitivity and a smaller improvement in LV diastolic function than F-.
遗传因素在胰岛素抵抗与高血压的关联中起重要作用，同时也影响降压治疗期间的胰岛素敏感性变化。本研究旨在评估高血压的遗传易感性是否也会影响降压治疗期间的左心室（LV）变化。
我们纳入了36例未经治疗的高血压患者：18例父母均为高血压患者（F+）和18例父母均为血压正常者（F-），两组在年龄、性别和体重指数（BMI）方面相匹配。患者在接受依那普利治疗2.5年前后各评估一次。在两次评估时，患者均接受：24小时血压（BP）监测、左心室超声心动图检查以及口服葡萄糖耐量试验，并测量血糖和胰岛素水平。
在基础评估时，两组在性别、年龄、BMI、24小时血压和空腹血糖方面无差异；F+组的葡萄糖代谢清除率显著较低。两组之间的左心室质量指数相似，而F+组的舒张参数显著较低。在第二次评估时，两组的24小时血压和左心室质量均下降至相同程度；F-组的葡萄糖代谢清除率显著增加，而F+组保持不变。两组均发现左心室舒张功能有所改善，F-组的改善更为显著。
高血压的遗传易感性除了影响胰岛素敏感性外，还会影响降压治疗期间的左心室功能变化。尽管24小时血压和左心室质量下降程度相似，但F+组患者的胰岛素敏感性无变化，且左心室舒张功能的改善程度小于F-组。
