Heinemann L, Heise T, Ampudia J, Sawicki P, Sindelka G, Brunner G, Starke A A
Department of Metabolic Diseases and Nutrition, Heinrich-Heine-University Düsseldorf, Germany.
Eur J Clin Invest. 1995 Aug;25(8):595-600. doi: 10.1111/j.1365-2362.1995.tb01751.x.
In most, but not all, studies antihypertensive treatment with angiotensin converting enzyme inhibitors (ACE inhibitors) improves insulin sensitivity, whereas beta-blockers decrease insulin sensitivity. However, there was a significant increase in body weight with beta-blockers and changes in the body potassium homeostasis with ACE inhibitors. In order to compare the drug specific metabolic effects of an ACE inhibitor and a cardioselective beta-blocker controlling these factors, we measured insulin sensitivity in a randomized, double-blind cross-over study in 22 healthy volunteers (age 27 +/- 3 years; BMI 22.0 +/- 1.5 kg m-2 (mean +/- SD)) during euglycaemic glucose clamps before and after 4 weeks' administration of 5 mg Lisinopril or 5 mg Bisoprolol. Both drug phases were separated by 4 weeks of no drug administration. During the insulin sensitivity measurements potassium concentrations were clamped at basal levels by means of a variable i.v. potassium infusion. Body weight was monitored at weekly intervals and kept constant within +/- 1 kg of the subjects' baseline weight throughout the entire study period. Insulin sensitivity did not change significantly during either drug administration period. The insulin sensitivity index of the 22 volunteers after administration of the ACE inhibitor was 7.9 +/- 2.4 mL min-1 m2 microU-1 mL-1 (basal index 8.3 +/- 1.9 mL min-1 m2 microU-1 mL-1, and 7.5 +/- 2.1 mL min-1 m2 microU-1 mL-1 after administration of the beta-blocker (basal index 8.2 +/- 1.9 mL min-1 m2 microU-1 mL-1; NS).(ABSTRACT TRUNCATED AT 250 WORDS)
在大多数（但并非所有）研究中，使用血管紧张素转换酶抑制剂（ACE抑制剂）进行抗高血压治疗可改善胰岛素敏感性，而β受体阻滞剂则会降低胰岛素敏感性。然而，使用β受体阻滞剂会使体重显著增加，使用ACE抑制剂会使体内钾稳态发生变化。为了比较一种ACE抑制剂和一种心脏选择性β受体阻滞剂在控制这些因素方面的药物特异性代谢效应，我们在22名健康志愿者（年龄27±3岁；体重指数22.0±1.5 kg·m⁻²（均值±标准差））中进行了一项随机、双盲交叉研究，在给予5 mg赖诺普利或5 mg比索洛尔4周前后，通过正常血糖葡萄糖钳夹测量胰岛素敏感性。两个药物阶段之间间隔4周不服用药物。在胰岛素敏感性测量期间，通过可变静脉输注钾将钾浓度维持在基础水平。每周监测体重，并在整个研究期间将体重保持在受试者基线体重±1 kg范围内。在任何一个药物给药期间，胰岛素敏感性均未发生显著变化。22名志愿者在服用ACE抑制剂后的胰岛素敏感性指数为7.9±2.4 mL·min⁻¹·m²·μU⁻¹·mL⁻¹（基础指数8.3±1.9 mL·min⁻¹·m²·μU⁻¹·mL⁻¹），服用β受体阻滞剂后为7.5±2.1 mL·min⁻¹·m²·μU⁻¹·mL⁻¹（基础指数8.2±1.9 mL·min⁻¹·m²·μU⁻¹·mL⁻¹；无显著性差异）。（摘要截断于250字）
