肾上腺素能阻滞剂改善了清晨高血压患者的胰岛素抵抗：日本清晨高血压研究-1

Adrenergic blockade improved insulin resistance in patients with morning hypertension: the Japan Morning Surge-1 Study.

作者信息

Shibasaki Seiichi, Eguchi Kazuo, Matsui Yoshio, Ishikawa Joji, Hoshide Satoshi, Ishikawa Shizukiyo, Kabutoya Tomoyuki, Pickering Thomas G, Shimada Kazuyuki, Kario Kazuomi

机构信息

Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.

出版信息

J Hypertens. 2009 Jun;27(6):1252-7. doi: 10.1097/hjh.0b013e32832a6d6a.

DOI:10.1097/hjh.0b013e32832a6d6a

PMID:19462498

Abstract

BACKGROUND

It has been demonstrated that insulin resistance is associated with morning hypertension. We investigated the hypothesis that the lowering of morning blood pressure (BP) can improve insulin resistance in patients with morning hypertension.

METHODS

In the present study, 611 treated hypertensive patients with morning hypertension were randomized into either a doxazosin group, for whom a once-daily bedtime dose of doxazosin was added to the current medication regimen, or a control group, who continued their current medication. The homeostasis model assessment of the insulin resistance index (HOMA-IR) was performed at baseline and the 6th month of treatment. The associations between change in HOMA-IR and changes in systolic BP (SBP) measures were assessed by multiple regression analyses with adjustment for covariates.

RESULTS

HOMA-IR was significantly decreased in the doxazosin group (2.1 +/- 3.0 to 1.8 +/- 2.6, P = 0.04) but not in the control group. The change in HOMA-IR was significantly associated with the change in morning SBP (r = 0.10, P = 0.02) but not with evening SBP. In multiple regression analysis, the change in HOMA-IR was independently and significantly associated with the change in morning SBP (beta = 0.15, P = 0.016) but not with the change in evening SBP.

CONCLUSION

In patients with morning hypertension, specific treatment for morning hypertension with an adrenergic blockade has a beneficial effect on insulin resistance.

摘要

背景

已有研究表明胰岛素抵抗与清晨高血压相关。我们探讨了降低清晨血压（BP）能否改善清晨高血压患者胰岛素抵抗这一假说。

方法

在本研究中，611例接受治疗的清晨高血压患者被随机分为多沙唑嗪组，即在当前药物治疗方案基础上加用每日一次睡前剂量的多沙唑嗪，以及对照组，即继续当前药物治疗。在基线和治疗第6个月时进行胰岛素抵抗指数的稳态模型评估（HOMA-IR）。通过对协变量进行调整的多元回归分析评估HOMA-IR变化与收缩压（SBP）测量值变化之间的关联。

结果

多沙唑嗪组的HOMA-IR显著降低（从2.1±3.0降至1.8±2.6，P = 0.04），而对照组未降低。HOMA-IR的变化与清晨SBP的变化显著相关（r = 0.10，P = 0.02），但与夜间SBP无关。在多元回归分析中，HOMA-IR的变化与清晨SBP的变化独立且显著相关（β = 0.15，P = 0.016），但与夜间SBP的变化无关。