Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, 1600 SW Archer Rd, Box 100486, Gainesville, FL 32610-0486, USA.
Hypertension. 2010 Jan;55(1):61-8. doi: 10.1161/HYPERTENSIONAHA.109.139592. Epub 2009 Nov 16.
We assessed adverse metabolic effects of atenolol and hydrochlorothiazide among hypertensive patients with and without abdominal obesity using data from a randomized, open-label study of hypertensive patients without evidence of cardiovascular disease or diabetes mellitus. Intervention included randomization to 25 mg of hydrochlorothiazide or 100 mg of atenolol monotherapy followed by their combination. Fasting glucose, insulin, triglycerides, high-density lipoprotein cholesterol, and uric acid levels were measured at baseline and after monotherapy and combination therapy. Outcomes included new occurrence of and predictors for new cases of glucose > or =100 mg/dL (impaired fasting glucose), triglyceride > or =150 mg/dL, high-density lipoprotein < or =40 mg/dL for men or < or =50 mg/dL for women, or new-onset diabetes mellitus according to the presence or absence of abdominal obesity. Abdominal obesity was present in 167 (58%) of 395 patients. Regardless of strategy, in those with abdominal obesity, 20% had impaired fasting glucose at baseline compared with 40% at the end of study (P<0.0001). Proportion with triglycerides > or =150 mg/dL increased from 33% at baseline to 46% at the end of study (P<0.01). New-onset diabetes mellitus occurred in 13 patients (6%) with and in 4 patients (2%) without abdominal obesity. Baseline levels of glucose, triglyceride, and high-density lipoprotein predicted adverse outcomes, and predictors for new-onset diabetes mellitus after monotherapy in those with abdominal obesity included hydrochlorothiazide strategy (odds ratio: 46.91 [95% CI: 2.55 to 862.40]), female sex (odds ratio: 31.37 [95% CI: 2.10 to 468.99]), and uric acid (odds ratio: 3.19 [95% CI: 1.35 to 7.52]). Development of adverse metabolic effect, including new-onset diabetes mellitus associated with short-term exposure to hydrochlorothiazide and atenolol was more common in those with abdominal obesity.
我们评估了在没有心血管疾病或糖尿病证据的高血压患者中，使用数据来自一项随机、开放标签的研究，比较了腹部肥胖的高血压患者使用阿替洛尔和氢氯噻嗪的不良代谢效应。干预措施包括随机分配到 25 毫克氢氯噻嗪或 100 毫克阿替洛尔单药治疗，然后联合用药。在基线和单药及联合治疗后测量空腹血糖、胰岛素、甘油三酯、高密度脂蛋白胆固醇和尿酸水平。结果包括新出现的和预测新病例的葡萄糖 >或=100mg/dL（空腹血糖受损）、甘油三酯 >或=150mg/dL、男性高密度脂蛋白 <或=40mg/dL 或女性 <或=50mg/dL，或根据是否存在腹部肥胖，出现新诊断的糖尿病。在 395 例患者中有 167 例（58%）存在腹部肥胖。无论治疗策略如何，在有腹部肥胖的患者中，基线时有 20%的人空腹血糖受损，而研究结束时有 40%（P<0.0001）。基线时有 33%的患者甘油三酯 >或=150mg/dL，研究结束时有 46%（P<0.01）。有 13 例（6%）伴有腹部肥胖和 4 例（2%）无腹部肥胖的患者出现新发糖尿病。基线时的血糖、甘油三酯和高密度脂蛋白水平预测不良结局，并且在有腹部肥胖的患者中单药治疗后发生新诊断糖尿病的预测因素包括氢氯噻嗪治疗策略（比值比：46.91[95%可信区间：2.55 至 862.40]）、女性（比值比：31.37[95%可信区间：2.10 至 468.99]）和尿酸（比值比：3.19[95%可信区间：1.35 至 7.52]）。在有腹部肥胖的患者中，短期暴露于氢氯噻嗪和阿替洛尔引起的不良代谢效应，包括新发糖尿病的发生率更高。
