Human Neurotransmitters Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia.
Hypertens Res. 2012 Jan;35(1):41-7. doi: 10.1038/hr.2011.134. Epub 2011 Aug 4.
The present study compared the effectiveness of a mild calorie-restricted diet (D) alone, exercise (EX) alone and a combination of D+EX on weight loss-induced blood pressure (BP) reduction over 24 weeks. We focussed especially on the relationship between sympathetic nervous activity, as indicated from measures of plasma norepinephrine (NE), and insulin resistance (homeostasis model of insulin resistance, HOMA-IR). The three groups each comprised 30 obese, hypertensive men. Body mass index (BMI), fat mass, waist-to-hip ratio, BP, plasma NE and HOMA-IR were measured every 2 weeks during the first 4 weeks and subsequently every 4 weeks for the next 20 weeks. All basal parameters were similar among the three groups. At 24 weeks, the combination group with D+EX comprised a significantly higher prevalence of normotensive subjects than the D alone or EX alone group (P<0.05). In the D alone group, plasma NE was decreased significantly at 2 weeks, reductions in BMI, fat mass and BP were observed at 8 weeks, and waist-to-hip ratios and HOMA-IR were decreased at 12 weeks. In comparison, in the EX alone group, significant reductions of fat mass and HOMA-IR were observed at 4 weeks. Plasma NE and HOMA-IR were reduced at 8 weeks while decreases in BP were detected at 12 weeks. In the D+EX group, significant reductions in plasma NE were observed at 2 weeks followed by significant decreases in BMI, fat mass, waist-to-hip ratio, BP levels and HOMA-IR at 4 weeks. The magnitudes of reductions of all parameters were greatest in the D+EX group. These results demonstrate that D+EX exerts a stronger ameliorative effect on weight loss, weight loss-induced BP reduction, normalization of BP, sympathetic activation and insulin resistance compared with D or EX alone. D and EX might, perhaps, exert different mechanisms on weight loss and weight loss-induced BP reduction; however, a combination of caloric restriction and exercise is preferred to control BP levels in obese hypertensive patients.
本研究比较了温和热量限制饮食（D）、运动（EX）单独作用以及 D+EX 联合作用在 24 周内减轻体重诱导的血压（BP）降低的效果。我们特别关注了交感神经活性的关系，其通过血浆去甲肾上腺素（NE）的测量来表示，以及胰岛素抵抗（胰岛素抵抗的稳态模型，HOMA-IR）。三组各由 30 名肥胖、高血压男性组成。体重指数（BMI）、脂肪量、腰臀比、BP、血浆 NE 和 HOMA-IR 在最初的 4 周内每 2 周测量一次，随后在接下来的 20 周内每 4 周测量一次。三组的所有基础参数均相似。24 周时，D+EX 联合组的正常血压受试者比例明显高于 D 组或 EX 组（P<0.05）。在 D 组中，血浆 NE 在第 2 周显著降低，BMI、脂肪量和 BP 在第 8 周降低，腰臀比和 HOMA-IR 在第 12 周降低。相比之下，在 EX 组中，脂肪量和 HOMA-IR 在第 4 周显著降低。血浆 NE 和 HOMA-IR 在第 8 周降低，BP 在第 12 周降低。在 D+EX 组中，血浆 NE 在第 2 周显著降低，随后在第 4 周 BMI、脂肪量、腰臀比、BP 水平和 HOMA-IR 显著降低。所有参数的降低幅度在 D+EX 组中最大。这些结果表明，与 D 或 EX 单独作用相比，D+EX 对体重减轻、体重减轻诱导的 BP 降低、BP 正常化、交感神经激活和胰岛素抵抗具有更强的改善作用。D 和 EX 可能对体重减轻和体重减轻诱导的 BP 降低有不同的作用机制；然而，热量限制和运动的结合更有利于控制肥胖高血压患者的 BP 水平。
