Skyler J S, Marks J B, Schneiderman N
Department of Medicine, University of Miami, Florida, USA.
Am J Hypertens. 1995 Dec;8(12 Pt 2):100s-105s. doi: 10.1016/0895-7061(95)00307-x.
Diabetes mellitus and hypertension each confer increased cardiovascular risk. That risk is much greater when the diseases coexist and is further magnified by their frequent association with dyslipidemia and central obesity. Insulin resistance appears to be an important common component to these four entities, whether or not the relationship is truly cause and effect. Increased renal tubule absorption of sodium and increased sympathetic nervous system stimulation from insulin have been said to be the mechanisms by which elevated levels of insulin cause hypertension. However, animal experiments suggest that these are short-term effects only and that long-term insulin may actually increase peripheral blood flow and reduce blood pressure. Experiments in humans suggest that the insulin resistant state in obese patients and type II diabetics is associated with a decrease of the usual vasodilatory effect of insulin. Antihypertensive drugs have differing effects on insulin resistance. Angiotensin converting enzyme inhibitors, alpha-adrenergic blockers, and dihydropyridines appear to improve insulin sensitivity. Other calcium channel blockers appear to be neutral, as is furosemide. Thiazide diuretics, spironolactone, and beta-adrenergic blockers impair insulin sensitivity. The drugs that increase insulin sensitivity also tend to improve dyslipidemia or remain lipid neutral. In contrast, those drugs that tend to impair insulin sensitivity also tend to worsen dyslipidemia.
糖尿病和高血压各自都会增加心血管疾病风险。当这两种疾病同时存在时，这种风险会大得多，并且由于它们经常与血脂异常和中心性肥胖相关联，风险会进一步放大。胰岛素抵抗似乎是这四种情况的一个重要共同因素，无论这种关系是否真的是因果关系。肾小管对钠的重吸收增加以及胰岛素引起的交感神经系统刺激增加被认为是胰岛素水平升高导致高血压的机制。然而，动物实验表明这些只是短期效应，长期胰岛素实际上可能会增加外周血流量并降低血压。人体实验表明，肥胖患者和II型糖尿病患者的胰岛素抵抗状态与胰岛素通常的血管舒张作用减弱有关。抗高血压药物对胰岛素抵抗有不同的影响。血管紧张素转换酶抑制剂、α-肾上腺素能阻滞剂和二氢吡啶类药物似乎能改善胰岛素敏感性。其他钙通道阻滞剂似乎是中性的，速尿也是如此。噻嗪类利尿剂、螺内酯和β-肾上腺素能阻滞剂会损害胰岛素敏感性。增加胰岛素敏感性的药物也往往会改善血脂异常或保持血脂中性。相比之下，那些往往会损害胰岛素敏感性的药物也往往会使血脂异常恶化。
