Schnack C, Hoffmann W, Hopmeier P, Schernthaner G
Department of Medicine 1, Rudolfstiftung Hospital, Vienna, Austria.
Diabetologia. 1996 Dec;39(12):1611-6. doi: 10.1007/s001250050623.
The clinical importance of selection of different antihypertensive drugs for the treatment of diabetic patients is still unclear. Thus we performed a randomised, controlled study in 105 hypertensive non-insulin-dependent diabetic (NIDDM) patients with microalbuminuria over 1 year. Patients received either the angiotensin converting enzyme (ACE) inhibitor ramipril (2.5-5.0 mg/day; in addition 24% of patients also received felodipine) or the beta blocking agent atenolol (50-100 mg/day; in addition 24% of patients also received hydrochlorothiazide). Blood pressure, metabolic control, lipid levels and albumin excretion rate were studied during the follow-up. After 1 year an almost identical fall (p < 0.001) in blood pressure was observed with ramipril (170/100 vs 150/ 85 mmHg, median) and atenolol (180/100 vs 150/ 80 mmHg, median). With ramipril a reduction of total cholesterol (6.3 vs 5.9 mmol/l), of LDL cholesterol (3.8 vs 3.6 mmol/l) and HDL cholesterol (1.3 vs 1.2 mmol/l) was found, whereas triglycerides slightly increased (1.8 vs 2.0 mmol/l). With atenolol a similar reduction of total cholesterol (6.3 vs 5.9 mmol/l), LDL cholesterol (3.8 vs 3.7 mmol/l) and HDL cholesterol (1.4 vs 1.2 mmol/l) and an increase of triglycerides (1.4 vs 1.7 mmol/l) was noted. Metabolic control of the patients was maintained with both ramipril and atenolol treatment. With ramipril treatment urinary albumin creatinine ratio (14.4 vs 13.8 mg/mmol) and creatinine clearance (82 vs 84 ml/min) were constant, but with atenolol an increase of albumin creatinine ratio (13.9 vs 19 mg/mmol, p < 0.001) and a slight decrease of creatinine clearance (80 vs 66 ml/min, p < 0.05, not significant after Bonferroni correction) was observed.
1-year treatment of NIDDM patients with ramipril or atenolol does not influence metabolic control, the changes in serum lipids were similar. Despite almost identical blood pressure reduction in both groups the albumin creatinine ratio was constant under ramipril, but increased under atenolol treatment.
选择不同的抗高血压药物治疗糖尿病患者的临床重要性仍不明确。因此，我们对105例患有微量白蛋白尿的高血压非胰岛素依赖型糖尿病（NIDDM）患者进行了为期1年的随机对照研究。患者分别接受血管紧张素转换酶（ACE）抑制剂雷米普利（2.5 - 5.0毫克/天；此外，24%的患者还接受了非洛地平）或β受体阻滞剂阿替洛尔（50 - 100毫克/天；此外，24%的患者还接受了氢氯噻嗪）治疗。在随访期间研究了血压、代谢控制、血脂水平和白蛋白排泄率。1年后，雷米普利（中位数：170/100 vs 150/85毫米汞柱）和阿替洛尔（中位数：180/100 vs 150/80毫米汞柱）使血压下降幅度几乎相同（p < 0.001）。使用雷米普利时，总胆固醇（6.3 vs 5.9毫摩尔/升）、低密度脂蛋白胆固醇（3.8 vs 3.6毫摩尔/升）和高密度脂蛋白胆固醇（1.3 vs 1.2毫摩尔/升）降低，而甘油三酯略有升高（1.8 vs 2.0毫摩尔/升）。使用阿替洛尔时，总胆固醇（6.3 vs 5.9毫摩尔/升）、低密度脂蛋白胆固醇（3.8 vs 3.7毫摩尔/升）和高密度脂蛋白胆固醇（1.4 vs 1.2毫摩尔/升）有类似程度的降低，甘油三酯升高（1.4 vs 1.7毫摩尔/升）。雷米普利和阿替洛尔治疗均维持了患者的代谢控制。雷米普利治疗时尿白蛋白肌酐比值（14.4 vs 13.8毫克/毫摩尔）和肌酐清除率（82 vs 84毫升/分钟）保持稳定，但阿替洛尔治疗时白蛋白肌酐比值升高（13.9 vs 19毫克/毫摩尔，p < 0.001），肌酐清除率略有下降（80 vs 66毫升/分钟，p < 0.05，经Bonferroni校正后无统计学意义）。
用雷米普利或阿替洛尔对NIDDM患者进行1年治疗不影响代谢控制，血脂变化相似。尽管两组血压下降幅度几乎相同，但雷米普利治疗时白蛋白肌酐比值保持稳定，而阿替洛尔治疗时该比值升高。
