SaizSatjes Margarita, Martinez-Martin Francisco Javier
Hospital Universitario Mutua Terrassa, Barcelona, Spain.
Outpatient Hypertension Clinic, University Hospital of Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain.
Drugs Context. 2018 Jan 3;7:212509. doi: 10.7573/dic.212509. eCollection 2018.
Antihypertensive treatment of patients with diabetes should include those drugs with a positive effect on metabolic parameters. Most patients with diabetes require at least two antihypertensive agents. Combining a dihydropyridine calcium channel blocker with a renin-angiotensin-aldosterone system inhibitor is a rational approach. However, not all dihydropyridines are equal with respect to their effects on metabolic parameters. Thus, manidipine exerts a positive effect on insulin resistance. However, this effect has not been observed with amlodipine. On the other hand, the excessive activation of sympathetic nervous system has been related with an increase of insulin resistance, pulse pressure, and ankle edema rates. Compared with amlodipine, manidipine activates sympathetic nervous system to a lesser extent. As a result, treatment with manidipine represents a good option in hypertensive patients with diabetes.
糖尿病患者的降压治疗应包括那些对代谢参数有积极作用的药物。大多数糖尿病患者至少需要两种降压药。将二氢吡啶类钙通道阻滞剂与肾素-血管紧张素-醛固酮系统抑制剂联合使用是一种合理的方法。然而，并非所有二氢吡啶类药物对代谢参数的影响都是相同的。因此，马尼地平对胰岛素抵抗有积极作用。然而，氨氯地平并未观察到这种作用。另一方面，交感神经系统的过度激活与胰岛素抵抗、脉压和踝部水肿发生率的增加有关。与氨氯地平相比，马尼地平对交感神经系统的激活程度较小。因此，对于糖尿病高血压患者，马尼地平治疗是一个不错的选择。
