Statsenko M E, Derevianchenko M V
Ter Arkh. 2014;86(8):90-3.
To evaluate the impact of 6-month antihypertensive therapy with the combined drug amlodipine + lisinopril (ekvator) on endothelial dysfunction (ED) and carbohydrate metabolic parameters in patients with hypertension and type 2 diabetes mellitus (DM).
The investigation enrolled 30 patients aged 40-65 years with Stages II-III hypertension concurrent with type 2 DM. All the patients received combined antihypertensive therapy with amlodipine + lisinopril for 24 weeks. Endothelial function (EF) was studied from the serum and urine concentrations of the metabolites nitric oxide (NO) and endothelin-1 (ET-1) and from occlusion test results. Carbohydrate metabolic parameters were estimated. Insulin resistance (IR) was judged from basal insulin concentrations, followed by the calculations of the Homeostasis Model Assessment (HOMA) index.
Following 24 weeks of therapy with amlodipine + lisinopril and close adherence to dietary recommendations, all the patients achieved the target levels of blood pressure and glycated hemoglobin (HbA1c). There was a significant improvement in EF in hypertensive patients with type 2 DM: NO production was increased in both the serum and urine (by 122.8 and 65.8%, respectively). ET-1 secretion was naturally decreased in both the serum and urine (by 26.1 and 76.1%, respectively; p < 0.05). Analysis of the vascular component of EF during treatment with the combined drug amlodipine + lisinopril revealed a statistically significant patient redistribution by the types of microcirculation and the results of an occlusion test, by calculating the responsiveness of large arteries: the number of patients with normal microcirculation increased from 13.3 to 86.7% and that of patients with hyperemic microcirculation declined from 66.7 to 0. The number of patients with a paradoxical occlusion test significantly reduced from 46.7% at baseline to 20% after 24 weeks of treatment with the combined medication amlodipine + lisinopril. Fasting blood glucose levels and HOMA index were decreased by 22.1 and 22.4%, respectively (p < 0.05). There were statistically significant correlations between the HOMA index and the concentrations of NO in the urine (r = -0.45) and blood (r = -0.54) and those of ET-1 in the blood (r = -0.54).
Twenty-four-week combined antihypertensive therapy with the drug amlodipine + lisinopril is safe and highly effective in EF recovery and favorably affects carbohydrate metabolic parameters in the hypertensive patients with type 2 DM.
评估氨氯地平+赖诺普利复方制剂（依卡特）6个月的降压治疗对高血压合并2型糖尿病患者内皮功能障碍（ED）和碳水化合物代谢参数的影响。
本研究纳入了30例年龄在40 - 65岁之间、患有II - III期高血压并伴有2型糖尿病的患者。所有患者接受氨氯地平+赖诺普利联合降压治疗24周。通过血清和尿液中一氧化氮（NO）和内皮素-1（ET-1）代谢产物的浓度以及闭塞试验结果来研究内皮功能（EF）。评估碳水化合物代谢参数。根据基础胰岛素浓度判断胰岛素抵抗（IR），随后计算稳态模型评估（HOMA）指数。
经过24周氨氯地平+赖诺普利治疗并严格遵循饮食建议后，所有患者均达到了血压和糖化血红蛋白（HbA1c）的目标水平。2型糖尿病高血压患者的EF有显著改善：血清和尿液中的NO生成均增加（分别增加了122.8%和65.8%）。血清和尿液中的ET-1分泌自然减少（分别减少了26.1%和76.1%；p < 0.05）。通过计算大动脉的反应性，分析氨氯地平+赖诺普利联合用药治疗期间EF的血管成分，发现患者按微循环类型和闭塞试验结果进行了具有统计学意义的重新分布：微循环正常的患者数量从13.3%增加到86.7%，充血性微循环患者数量从66.7%下降到0。矛盾性闭塞试验患者数量从基线时的46.7%显著减少到联合用药氨氯地平+赖诺普利治疗24周后的20%。空腹血糖水平和HOMA指数分别降低了22.1%和22.4%（p < 0.05）。HOMA指数与尿液（r = -0.45）和血液（r = -0.54）中NO的浓度以及血液中ET-1的浓度之间存在统计学显著相关性（r = -0.54）。
氨氯地平+赖诺普利联合用药24周的降压治疗对恢复2型糖尿病高血压患者的EF安全且高效，并对碳水化合物代谢参数有有利影响。
