Mykkänen L, Kuusisto J, Pyörälä K, Laakso M, Haffner S M
University of Kuopio, Department of Medicine, Finland.
J Hypertens. 1994 Dec;12(12):1425-32.
In several studies hypertension has been shown to be associated with an increased incidence of non-insulin-dependent diabetes mellitus (NIDDM). This may be due to hypertension itself or to the deleterious effects of some antihypertensive agents on glucose tolerance and insulin sensitivity.
We examined the 3.5-year incidence of diabetes mellitus in relation to hypertension and antihypertensive medication in a population-based study of elderly subjects (n = 805) aged 65-74 years in Kuopio, Finland.
Of the subjects studied, 60% had hypertension at baseline and 50% of the hypertensive subjects were on drug therapy at baseline. Hypertensive subjects had a significantly higher incidence of NIDDM than non-hypertensive subjects. However, after adjustment for age, body mass index, waist: hip ratio, sex, and fasting glucose and insulin levels, the increased risk of NIDDM in hypertensive subjects was no longer statistically significant. Subjects with high blood pressure (> or = 160/95 mmHg) at the baseline examination who were not taking beta-blockers or diuretic medication had a 1.56-fold increased risk of developing NIDDM, whereas subjects with hypertension who were taking those agents had a 1.88-fold risk of developing NIDDM compared with subjects with normal blood pressure. The risk of developing NIDDM was accompanied by elevated fasting insulin levels. After adjustment for age, sex, body mass index, waist:hip ratio, and fasting glucose and insulin levels, hypertensive subjects taking diuretics or beta-blockers, or both, still had a 1.56-fold increased risk of developing NIDDM relative to normotensive subjects. Hypertensive subjects taking diuretics or beta-blockers, or both, had a significantly higher incidence of NIDDM than hypertensive subjects not on pharmacological therapy. However, after adjustment for 2-h glucose and insulin concentrations, the incidence of NIDDM did not differ between the hypertensive subjects.
The data presented suggest that the increased risk of NIDDM in hypertensive subjects taking beta-blockers or diuretics, or both, is explained at least partly by metabolic disturbances related to drug therapy.
多项研究表明，高血压与非胰岛素依赖型糖尿病（NIDDM）发病率的增加有关。这可能是由于高血压本身，或者是某些抗高血压药物对葡萄糖耐量和胰岛素敏感性的有害影响。
在芬兰库奥皮奥进行的一项针对65至74岁老年人群（n = 805）的基于人群的研究中，我们研究了糖尿病的3.5年发病率与高血压及抗高血压药物的关系。
在所研究的受试者中，60%在基线时患有高血压，50%的高血压受试者在基线时接受药物治疗。高血压受试者的NIDDM发病率显著高于非高血压受试者。然而，在调整年龄、体重指数、腰臀比、性别以及空腹血糖和胰岛素水平后，高血压受试者患NIDDM的风险增加不再具有统计学意义。基线检查时血压高（≥160/95 mmHg）且未服用β受体阻滞剂或利尿剂的受试者患NIDDM的风险增加了1.56倍，而服用这些药物的高血压受试者患NIDDM的风险是血压正常受试者的1.88倍。患NIDDM的风险伴随着空腹胰岛素水平的升高。在调整年龄、性别、体重指数、腰臀比以及空腹血糖和胰岛素水平后，服用利尿剂或β受体阻滞剂或两者都服用的高血压受试者相对于血压正常的受试者患NIDDM的风险仍然增加了1.56倍。服用利尿剂或β受体阻滞剂或两者都服用的高血压受试者的NIDDM发病率显著高于未接受药物治疗的高血压受试者。然而，在调整2小时血糖和胰岛素浓度后，高血压受试者之间的NIDDM发病率没有差异。
所呈现的数据表明，服用β受体阻滞剂或利尿剂或两者都服用的高血压受试者患NIDDM风险增加至少部分是由与药物治疗相关的代谢紊乱所解释的。
