Hrnciar J, Hrnciarová M, Jakubíková K
Interná klinika A nemocnice F.D. Roosevelta, Banská Bystrica.
Vnitr Lek. 1997 Feb;43(2):74-80.
Base on their own experience with isradipine and results of a multicentric study with amplodipine in the Slovak Republic, as well as based on data in the literature the authors conclude that: 1. In the treatment of arterial hypertension associated in the syndrome of insulin resistance (syndrome X and 5H resp.) with type 2 diabetes, hyperlipiproteinaemia and hyperinsulinism drugs of first choice include ACE-inhibitors and Ca antagonist of the second generation, dihydropiridine type, such as amplodipine, isradipine, fellodipine, nirtendipine etc. ACE inhibitors and Ca antagonist of the dihydropyridine type with prolonged effect have a good tolerance, few undesirable effect, a favourable effect on the decline of BP, regression of hypertrophy of the left ventricle and vascular wall; they do not cause deterioration of insulin resistance and thus do not interfere with compensation of diabetes and associated hyperlipoproteinaemia. 2. ACE inhibitors moreover reduce glomerular filtration and albuminuria and thus retard along with the effect on BP the progression of diabetic nephropathy. 3. In pre-existing hyporeninemic hypoaldosteronism (cca in 18% diabetic subjects) they can however cause dangerous hyperkalinaemia by further inhibition of the damaged renin-angiotensin-aldosterone system. In instances Ca inhibitors are indicated. The latter activate RAAS and do not have an impact on albuminuria. By their effect on the vas deferens they can increase glomerular filtration. 4. Diuretics are not suitable for the treatment of hypertension in X syndrome and the use of beta-blocking agents even with ISA and beta-1-selective preparations in restricted in particular when insulin is administered or other numerous contraindications are present (cardiac failure, bradyarrythmias, bronchitis etc.). Perhaps a combination of ACE-inhibitors and Ca antagonists of the 2nd generation with an alpha-blocking agent or hybrid alpha-beta-blocking agent is a suitable solution.
基于他们自身使用伊拉地平的经验以及斯洛伐克共和国一项关于氨氯地平的多中心研究结果，同时基于文献数据，作者得出以下结论：1. 在治疗与2型糖尿病、高脂蛋白血症和高胰岛素血症相关的胰岛素抵抗综合征（分别为X综合征和5H综合征）伴发的动脉高血压时，首选药物包括ACE抑制剂和第二代二氢吡啶类钙拮抗剂，如氨氯地平、伊拉地平、非洛地平、尼群地平等。具有长效作用的ACE抑制剂和二氢吡啶类钙拮抗剂耐受性良好，不良反应少，对血压下降、左心室肥厚和血管壁消退有良好作用；它们不会导致胰岛素抵抗恶化，因此不会干扰糖尿病和相关高脂蛋白血症的代偿。2. 此外，ACE抑制剂可降低肾小球滤过率和蛋白尿，从而在影响血压的同时延缓糖尿病肾病的进展。3. 然而，在已存在低肾素性低醛固酮血症（约18%的糖尿病患者）的情况下，它们可能通过进一步抑制受损的肾素 - 血管紧张素 - 醛固酮系统而导致危险的高钾血症。在这种情况下应选用钙抑制剂。钙抑制剂可激活肾素 - 血管紧张素 - 醛固酮系统，对蛋白尿无影响。通过对输精管的作用，它们可增加肾小球滤过率。4. 利尿剂不适合用于治疗X综合征的高血压，β受体阻滞剂的使用即使是具有内在拟交感活性（ISA）和β1选择性制剂也受到限制，特别是在使用胰岛素或存在其他多种禁忌证（心力衰竭、缓慢性心律失常、支气管炎等）时。也许ACE抑制剂和第二代钙拮抗剂与α受体阻滞剂或混合α - β受体阻滞剂联合使用是一种合适的解决方案。
