Health Center and Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
Clin Exp Hypertens. 2011;33(1):41-6. doi: 10.3109/10641963.2010.503301. Epub 2010 Dec 11.
Losartan, an angiotensin II receptor blocker (ARB), has been reported to increase serum level of high-molecular weight (HMW) adiponectin, which has beneficial effects on insulin resistance and atherosclerosis. On the other hand, treatment with diuretics was reported to decrease the adiponectin level. In the present study, we investigated the effects of changing the treatment to losartan/hydrochlorothiazide (HCTZ) on blood pressure (BP) and various metabolic parameters in Japanese male hypertensive subjects. This study included 15 subjects whose therapy was changed from a usual dosage of ARB to losartan 50mg/HCTZ 12.5mg daily, and also 14 subjects who continued losartan treatment (50mg/day). Serum HMW-adiponectin concentration was assayed using a commercially available HMW-specific ELISA kit. In the losartan/HCTZ patient group, systolic/diastolic BP decreased from 146/95 to 130/84 mmHg (P = 0.0012 for both). The HbA1c level tended to increase from 5.44 ± 0.39 to 5.55 ± 0.44% (P = 0.0554) and serum creatinine level slightly increased from 0.82 ± 0.12 to 0.87 ± 0.12 mg/dl (P = 0.0015). In contrast, serum TG (125 ± 77 to 149 ± 112 mg/dl), uric acid, and HMW-adiponectin levels (3.24 ± 2.97 to 3.36 ± 2.43 μg/ml) were unchanged. In the 14 patients who continued losartan treatment, systolic/diastolic BP was unchanged from 134/86 to 129/80 mmHg. The HbA1c level tended to increase from 5.26 ± 0.63 to 5.39 ± 0.71% (P = 0.0880), serum creatinine and uric acid levels were unchanged, serum lipids tended to improve, and serum HMW-adiponectin levels increased from 3.03 ± 1.06 to 3.46 ± 1.28 μg/ml (P = 0.0105). In summary, changing treatment to losartan/HCTZ, when changed from a usual dosage of ARB, exerted good BP control, while the HMW-adiponectin level was unchanged in male hypertensive subjects.
氯沙坦，一种血管紧张素 II 受体阻滞剂（ARB），据报道可增加血清高分子量（HMW）脂联素水平，这对胰岛素抵抗和动脉粥样硬化有益。另一方面，利尿剂治疗被报道会降低脂联素水平。在本研究中，我们研究了将治疗方法从常规剂量的 ARB 改为氯沙坦/氢氯噻嗪（HCTZ）对日本男性高血压患者的血压（BP）和各种代谢参数的影响。这项研究包括 15 名患者，他们的治疗方法从常规剂量的 ARB 改为氯沙坦 50mg/HCTZ 12.5mg 每日一次，还有 14 名继续接受氯沙坦治疗（50mg/天）的患者。使用市售的 HMW 特异性 ELISA 试剂盒测定血清 HMW-脂联素浓度。在氯沙坦/HCTZ 患者组中，收缩压/舒张压从 146/95mmHg 降至 130/84mmHg（P=0.0012）。HbA1c 水平从 5.44±0.39%倾向于升高至 5.55±0.44%（P=0.0554），血清肌酐水平从 0.82±0.12mg/dl 略有升高至 0.87±0.12mg/dl（P=0.0015）。相比之下，血清 TG（125±77 至 149±112mg/dl）、尿酸和 HMW-脂联素水平（3.24±2.97 至 3.36±2.43μg/ml）无变化。在继续接受氯沙坦治疗的 14 名患者中，收缩压/舒张压从 134/86mmHg 无变化至 129/80mmHg。HbA1c 水平从 5.26±0.63%倾向于升高至 5.39±0.71%（P=0.0880），血清肌酐和尿酸水平无变化，血脂水平倾向于改善，血清 HMW-脂联素水平从 3.03±1.06μg/ml 升高至 3.46±1.28μg/ml（P=0.0105）。总之，将治疗方法从常规剂量的 ARB 改为氯沙坦/HCTZ ，在男性高血压患者中可良好地控制血压，而 HMW-脂联素水平无变化。
