Anan F, Masaki T, Fukunaga N, Teshima Y, Iwao T, Kaneda K, Umeno Y, Okada K, Wakasugi K, Yonemochi H, Eshima N, Saikawa T, Yoshimatsu H
Faculty of Medicine, Oita University, Oita, Japan.
Eur J Clin Invest. 2007 Sep;37(9):709-14. doi: 10.1111/j.1365-2362.2007.01854.x.
Insulin resistance significantly correlated with a non-dipper type of essential hypertension. Thiazolidinediones (TZD), oral hypoglycaemic agents that act as insulin sensitizers, have been demonstrated in multiple in vivo and in vitro studies to possess antihypertensive properties. This study examined the efficacy of TZD therapy with pioglitazone at transforming the circadian rhythms of blood pressure from a non-dipper to a dipper type.
We examined 31 patients with type 2 diabetes mellitus during both a baseline period and a period of treatment with pioglitazone. Patients received 15 mg day(-1) pioglitazone for four weeks and 30 mg day(-1) for 12 weeks. Twenty-four hour ambulatory blood pressure monitoring (ABPM) and laboratory data (blood tests for cardiovascular risk factors) were obtained at the beginning and end of the study.
In non-dippers (n = 16), but not dippers (n = 15), we observed a significant interaction between pioglitazone therapy and nocturnal falls in systolic and diastolic blood pressure. This examination indicated that the magnitude of the nocturnal blood pressure fall was affected by pioglitazone therapy. In non-dippers, but not dippers, a significant correlation was observed between the percent decrease in nocturnal BP and the homeostasis model assessment (HOMA) index (r = 0.774, P = 0.0007).
The present study demonstrated that pioglitazone can restore the nocturnal BP declines in parallel to reductions in the HOMA index, suggesting that insulin resistance may play an important role in the genesis of circadian BP rhythms. TZD-based treatment may thus have the additional therapeutic advantage of reducing the risk of cardiovascular complications by transforming the circadian rhythm of BP.
胰岛素抵抗与原发性高血压的非勺型显著相关。噻唑烷二酮类药物（TZD）作为胰岛素增敏剂的口服降糖药，在多项体内和体外研究中已被证明具有降压特性。本研究考察了吡格列酮TZD疗法将血压昼夜节律从非勺型转变为勺型的疗效。
我们在基线期和吡格列酮治疗期对31例2型糖尿病患者进行了检查。患者接受15毫克/天（-1）吡格列酮治疗4周，然后30毫克/天（-1）治疗12周。在研究开始和结束时获得24小时动态血压监测（ABPM）和实验室数据（心血管危险因素血液检测）。
在非勺型患者（n = 16）中，而非勺型患者（n = 15）中，我们观察到吡格列酮治疗与夜间收缩压和舒张压下降之间存在显著交互作用。该检查表明夜间血压下降幅度受吡格列酮治疗影响。在非勺型患者中，而非勺型患者中，夜间血压下降百分比与稳态模型评估（HOMA）指数之间存在显著相关性（r = 0.774，P = 0.0007）。
本研究表明吡格列酮可使夜间血压下降与HOMA指数降低同步恢复，提示胰岛素抵抗可能在昼夜血压节律的发生中起重要作用。基于TZD的治疗可能因此具有通过改变血压昼夜节律降低心血管并发症风险的额外治疗优势。
