Lind L, Berne C, Pollare T, Lithell H
Department of Cardiology, University Hospital, Uppsala, Sweden.
J Intern Med. 1994 Jul;236(1):37-42. doi: 10.1111/j.1365-2796.1994.tb01117.x.
To evaluate the effects of isradipine alone and in combination with pindolol on glucose and lipid metabolism during long-term antihypertensive therapy.
Open long-term study with parallel groups.
Kungsgärdet Geriatric Hospital, Uppsala, a tertiary referral hospital.
Twenty-six untreated hypertensive subjects.
After 4 weeks on placebo, isradipine was titrated up to 10 mg daily to achieve appropriate blood pressure control (n = 11). If this failed, 5-10 mg pindolol was added. The treatments were continued for 2 years.
Blood pressure, lipoprotein measurements, intravenous glucose tolerance test, hyperinsulinaemic euglycaemic clamp, HbA1c, body weight.
Treatment with isradipine alone caused a sustained reduction in blood pressure (-22/-10 mm Hg, P < 0.01), but an increase in body weight (+2.2 kg, P < 0.05) and HbA1c (+1.5%; P < 0.001) were also noted. Addition of pindolol resulted in a similar degree of blood pressure reduction and weight gain, whilst HbA1c was less affected (+1.0%; P < 0.05, compared to isradipine alone). Insulin sensitivity became impaired in both groups (-1.2 to -1.5 mg kg-1 min-1; P < 0.01 for M-value at hyperinsulinaemic clamp) but after adjustment for the change in body weight the impairment was only significant (P < 0.01) in the group with combined treatment. The combined treatment also resulted in an increase in very-low-density-lipoprotein (VLDL) triglycerides (+ 0.37 mmol L-1; P < 0.05).
The hypotensive effect of isradipine was sustained during long-term use but was associated with weight gain and an impaired glucose control. When isradipine was combined with pindolol there was also a reduction in insulin sensitivity and an increase in VLDL triglycerides, possibly as effects of the beta-adrenergic blockade.
评估在长期抗高血压治疗中，单独使用伊拉地平以及伊拉地平与吲哚洛尔联合使用对糖脂代谢的影响。
平行组开放长期研究。
乌普萨拉的Kungsgärdet老年医院，一家三级转诊医院。
26名未经治疗的高血压患者。
服用安慰剂4周后，将伊拉地平剂量滴定至每日10mg以实现适当的血压控制（n = 11）。如果未能实现，则加用5 - 10mg吲哚洛尔。治疗持续2年。
血压、脂蛋白测量、静脉葡萄糖耐量试验、高胰岛素正常血糖钳夹试验、糖化血红蛋白（HbA1c）、体重。
单独使用伊拉地平治疗使血压持续降低（-22 / -10mmHg，P < 0.01），但也观察到体重增加（+2.2kg，P < 0.05）和糖化血红蛋白升高（+1.5%；P < 0.001）。加用吲哚洛尔导致类似程度的血压降低和体重增加，而糖化血红蛋白受影响较小（+1.0%；与单独使用伊拉地平相比，P < 0.05）。两组的胰岛素敏感性均受损（-1.2至-1.5mg·kg⁻¹·min⁻¹；高胰岛素钳夹试验中M值P < 0.01），但在调整体重变化后，联合治疗组的胰岛素敏感性受损才有统计学意义（P < 0.01）。联合治疗还导致极低密度脂蛋白（VLDL）甘油三酯升高（+ 0.37mmol·L⁻¹；P < 0.05）。
长期使用伊拉地平期间其降压效果持续存在，但与体重增加和血糖控制受损有关。当伊拉地平与吲哚洛尔联合使用时，胰岛素敏感性也会降低，极低密度脂蛋白甘油三酯升高，这可能是β - 肾上腺素能阻滞的作用。
