Hayden Melvin R, Sowers James R
Departments of Internal Medicine, Endocrinology Diabetes and Metabolism, and Diabetes and Cardiovascular Disease Research Center, School of Medicine, University of Missouri-Columbia, Health Sciences Center, Columbia, Missouri, USA.
J Am Soc Hypertens. 2008 Jul-Aug;2(4):239-66. doi: 10.1016/j.jash.2007.12.002. Epub 2008 Jun 2.
Hypertension, a multifactorial-polygenic disease, interacts with multiple environmental stressors and results in functional and structural changes in numerous end organs, including the cardiovascular system. This can result in coronary heart disease, stroke, peripheral vascular disease, congestive heart failure, end-stage renal disease, insulin resistance, and damage to the pancreatic islet. Hypertension is the most important modifiable risk factor for major health problems encountered in clinical practice. Whereas hypertension was once thought to be a medical condition based on discrete blood pressure readings, a new concept has emerged defining hypertension as part of a complex and progressive metabolic and cardiovascular disease, an important part of a cardiometabolic syndrome. The central role of insulin resistance, oxidative stress, endothelial dysfunction, metabolic signaling defects within tissues, and the role of enhanced tissue renin-angiotensin-aldosterone system activity as it relates to hypertension and type 2 diabetes mellitus are emphasized. Additionally, this review focuses on the effect of hypertension on functional and structural changes associated with the vulnerable pancreatic islet. Various classes of antihypertensive drugs are reviewed, especially their roles in delaying or preventing damage to the vulnerable pancreatic islet, and thus delaying the development of type 2 diabetes mellitus.
高血压是一种多因素多基因疾病，与多种环境应激源相互作用，导致包括心血管系统在内的众多终末器官发生功能和结构变化。这可引发冠心病、中风、外周血管疾病、充血性心力衰竭、终末期肾病、胰岛素抵抗以及胰岛损伤。高血压是临床实践中遇到的主要健康问题最重要的可改变风险因素。尽管高血压曾被认为是基于离散血压读数的一种病症，但一个新的概念已出现，将高血压定义为复杂且进行性代谢和心血管疾病的一部分，是心脏代谢综合征的重要组成部分。强调了胰岛素抵抗、氧化应激、内皮功能障碍、组织内代谢信号缺陷以及增强的组织肾素 - 血管紧张素 - 醛固酮系统活性在高血压和2型糖尿病中的作用。此外，本综述重点关注高血压对与易损胰岛相关的功能和结构变化的影响。对各类抗高血压药物进行了综述，尤其关注它们在延缓或预防易损胰岛损伤从而延缓2型糖尿病发生方面的作用。
