Maritz F J, Weich H F, Schoeman H S
Department of Internal Medicine, Tygerberg Hospital, W. Cape.
S Afr Med J. 1995 Dec;85(12 Pt 2):1342-5.
The metabolic effects of captopril 25 mg twice daily and atenolol 50 mg daily on glucose, insulin and lipids were compared in 83 otherwise healthy mild-to-moderate hypertensive between the ages of 25 and 60 years in a randomised double-blind trial. Hourly glucose and insulin levels were measured during a 2-hour 75 g oral glucose tolerance test at baseline and after 12 weeks of treatment. Lipid profiles including total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, HDL2, HDL3, triglycerides, apoprotein (Apo)A1, ApoB, and Apo(a) were obtained before and after the treatment period. Blood pressure decreased significantly and equivalently in both treatment groups. The glucose and insulin levels and glucose x insulin product at 2 hours after the glucose load increased after 12 weeks of treatment with atenolol compared with the baseline values, but these parameters all decreased after the treatment period with captopril compared with their baseline values. These results indicate an improvement in insulin sensitivity with captopril and a deterioration with atenolol. HDL-cholesterol and HDL3 decreased in the atenolol group but increased in the captopril group. We conclude that captopril has more favourable effects than atenolol on glucose, insulin and lipid metabolism in the treatment of mild-to-moderate hypertension.
在一项随机双盲试验中，对83名年龄在25至60岁之间、无其他健康问题的轻度至中度高血压患者，比较了每日两次服用25毫克卡托普利和每日服用50毫克阿替洛尔对血糖、胰岛素和血脂的代谢影响。在基线时以及治疗12周后，于2小时75克口服葡萄糖耐量试验期间每小时测量血糖和胰岛素水平。在治疗期前后获取血脂谱，包括总胆固醇、低密度脂蛋白（LDL）胆固醇、高密度脂蛋白（HDL）胆固醇、HDL2、HDL3、甘油三酯、载脂蛋白（Apo）A1、ApoB和Apo(a)。两个治疗组的血压均显著且同等程度下降。与基线值相比，阿替洛尔治疗12周后，葡萄糖负荷后2小时的血糖和胰岛素水平以及葡萄糖×胰岛素产物升高，但与基线值相比，卡托普利治疗期后这些参数均下降。这些结果表明卡托普利可改善胰岛素敏感性，而阿替洛尔则使其恶化。阿替洛尔组的高密度脂蛋白胆固醇和HDL3降低，而卡托普利组升高。我们得出结论，在治疗轻度至中度高血压方面，卡托普利对葡萄糖、胰岛素和脂质代谢的影响比阿替洛尔更有利。
