Stolk R P, Hoes A W, Pols H A, Hofman A, de Jong P T, Lamberts S W, Grobbee D E
Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands.
J Hypertens. 1996 Feb;14(2):237-42. doi: 10.1097/00004872-199602000-00013.
To investigate the association between insulin, hypertension and antihypertensive drug use in elderly patients.
Blood pressure, use of antihypertensive drugs and glucose metabolism were examined in 5453 men and women (mean age 68.8 years). This was part of the baseline examination of the Rotterdam Study, a population-based study of chronic diseases in elderly patients. Serum insulin was measured 2 h after an oral glucose load.
Patients with hypertension had a significantly higher mean post-load insulin level than those without: 71.3 mU/l versus 59.3 mU/l (P < 0.001, adjusted for age). Systolic blood pressure increased by 0.25 mmHg per 10 mU/l insulin (95% confidence interval 0.15-0.35, adjusted for age, sex and antihypertensive drugs), whereas the increase in diastolic blood was 0.07 mmHg per 10 mU/l (0.01-0.13). Whereas insulin resistance was higher in patients with hypertension, the increase in insulin resistance with age was much more apparent in normotensive patients, resulting in similar insulin levels at high ages. Those using antihypertensive drugs, however, had higher insulin levels at all ages.
The results of this study show that hyperinsulinemia is associated with raised blood pressure in elderly people, and suggest that the age-associated increase in insulin resistance is diminished in patients with raised blood pressure. The use of antihypertensive drugs, however, appears to be accompanied by an independent additional increase in insulin resistance at all ages.
研究老年患者胰岛素、高血压与抗高血压药物使用之间的关联。
对5453名男性和女性（平均年龄68.8岁）进行血压、抗高血压药物使用情况及糖代谢检查。这是鹿特丹研究基线检查的一部分，该研究是一项针对老年患者慢性病的基于人群的研究。口服葡萄糖负荷后2小时测量血清胰岛素。
高血压患者负荷后平均胰岛素水平显著高于非高血压患者：分别为71.3 mU/l和59.3 mU/l（P < 0.001，校正年龄后）。收缩压每10 mU/l胰岛素升高0.25 mmHg（95%置信区间0.15 - 0.35，校正年龄、性别和抗高血压药物后），而舒张压每10 mU/l升高0.07 mmHg（0.01 - 0.13）。虽然高血压患者胰岛素抵抗较高，但胰岛素抵抗随年龄的增加在血压正常的患者中更为明显，导致高龄时胰岛素水平相似。然而，使用抗高血压药物的患者在所有年龄段胰岛素水平都较高。
本研究结果表明，高胰岛素血症与老年人血压升高有关，并提示血压升高患者中与年龄相关的胰岛素抵抗增加有所减弱。然而，抗高血压药物的使用似乎在所有年龄段都伴随着胰岛素抵抗独立的额外增加。
