Bönner G, Schmieder R, Chrosch R, Weidinger G
Department of Internal Medicine II, University of Cologne, Köln, Germany.
Cardiovasc Drugs Ther. 1997 Mar;11(1):21-6. doi: 10.1023/a:1007735420758.
Antihypertensive drugs, recommended by the World Health Organization for use in monotherapy, exert different effects on glucose and lipid metabolism. In our study we compared the effects of the beta-blocker atenolol (AT) and the alpha1-blocker bunazosin (BU) on glucose metabolism. The doses administered were chosen to produce similar antihypertensive effects with both drugs. The study was conducted as a bicenter, parallel, controlled, and double-blind study. All patients suffered from mild to moderate primary hypertension, were obese (body mass index > 26 kg/m2), but were nondiabetic. After a drug-free period of 4 weeks, patients were treated either with 6 and 12 mg of bunazosin (n = 15) or with 50 and 100 mg of atenolol (n = 17) once daily for 12 weeks. Glucose metabolism was measured by the iv glucose tolerance test (GTT) and the euglycemic hyperinsulinemic clamp test. The results show a similar blood pressure reduction with both drugs. However, their effects on glucose metabolism were significantly (p < 0.05) different: The area under the curve (AUC) of glucose in the iv GTT increased 26.8% during atenolol treatment but decreased 30% during bunazosin treatment. The same influence on the AUC of insulin was observed [AT +478.5 +/- 441.8 (+22%) vs. BU, -588.5 +/- 411.1 (-22%)]. Similar changes were found in the glucose clamp test. The metabolic clearance rate increased 11.4% during bunazosin use and decreased 8.4% during atenolol use to the same degree that the insulin sensitivity index changed (BU +13.2% vs. AT -21.9%). The differences between the two treatment regimes were statistically significant (p < 0.05). These results in obese hypertensives confirm the well-known negative effects of beta-blockers on glucose metabolism. Additionally, they demonstrate that an alpha1-blocker such as bunazosin develops the same blood pressure-lowering effect as beta-blockers, but with a significantly better profile with regard to glucose metabolism. Therefore, the use of alpha1-blockers can be recommended for obese hypertensives without any special care for glucose metabolism.
世界卫生组织推荐用于单一疗法的抗高血压药物，对葡萄糖和脂质代谢有不同影响。在我们的研究中，我们比较了β受体阻滞剂阿替洛尔（AT）和α1受体阻滞剂布那唑嗪（BU）对葡萄糖代谢的影响。所给药的剂量选择为使两种药物产生相似的抗高血压作用。该研究作为一项双中心、平行、对照和双盲研究进行。所有患者患有轻度至中度原发性高血压，均为肥胖者（体重指数>26kg/m2），但均非糖尿病患者。经过4周的无药期后，患者分别接受6mg和12mg布那唑嗪（n = 15）或50mg和100mg阿替洛尔（n = 17）治疗，每日一次，持续12周。通过静脉葡萄糖耐量试验（GTT）和正常血糖高胰岛素钳夹试验测量葡萄糖代谢。结果显示两种药物的血压降低程度相似。然而，它们对葡萄糖代谢的影响有显著差异（p < 0.05）：静脉GTT中葡萄糖的曲线下面积（AUC）在阿替洛尔治疗期间增加了26.8%，而在布那唑嗪治疗期间降低了30%。观察到对胰岛素AUC有相同影响[阿替洛尔+478.5±441.8（+22%）与布那唑嗪，-588.5±411.1（-22%）]。在葡萄糖钳夹试验中发现了类似变化。布那唑嗪使用期间代谢清除率增加11.4%，阿替洛尔使用期间降低8.4%，与胰岛素敏感性指数变化程度相同（布那唑嗪+13.2%与阿替洛尔-21.9%）。两种治疗方案之间的差异具有统计学意义（p < 0.05）。这些肥胖高血压患者的结果证实了β受体阻滞剂对葡萄糖代谢的众所周知的负面影响。此外，它们表明像布那唑嗪这样的α1受体阻滞剂产生与β受体阻滞剂相同的降压效果，但在葡萄糖代谢方面有明显更好的表现。因此，对于肥胖高血压患者，无需对葡萄糖代谢进行任何特殊护理即可推荐使用α1受体阻滞剂。
