Wiggam M I, Hunter S J, Atkinson A B, Ennis C N, Henry J S, Browne J N, Sheridan B, Bell P M
Sir George E. Clark Metabolic Unit, Royal Victoria Hospital, Belfast, UK.
J Hypertens. 1998 Nov;16(11):1651-7. doi: 10.1097/00004872-199816110-00012.
To compare the effect of captopril with that of placebo on peripheral and hepatic insulin action in essential hypertension, in light of evidence that insulin resistance is associated with cardiovascular risk.
Randomized, double-blind, placebo-controlled, crossover trial, with 8 week treatment periods of captopril and placebo preceded and separated by 6 weeks of placebo.
Belfast teaching hospital.
Eighteen Caucasian nondiabetic patients (10 males), aged under 65 years, with essential hypertension, recruited from general practices in the greater Belfast area.
Captopril at 50 mg twice a day or placebo twice a day for two 8 week treatment periods.
Peripheral and hepatic insulin sensitivity assessed by glucose clamps.
Fourteen patients completed the study. Mean (+/- SEM) levels of fasting glucose, fasting insulin and postabsorptive hepatic glucose production were similar after captopril and placebo (5.4+/-0.1 versus 5.4+/-0.1 mmol/l, 10.6+/-2.2 versus 9.5+/-1.1 mU/l, 11.2+/-0.6 versus 11.0+/-0.5 mmol/kg per min, respectively). During hyperinsulinaemia, hepatic glucose production was suppressed to comparable levels after both treatments (4.8+/-0.6 versus 4.3+/-0.6 mmol/kg per min) and exogenous glucose infusion rates required to maintain euglycaemia were also similar (30.0+/-2.6 versus 30.3+/-2.6 mmol/kg per min).
Captopril therapy in uncomplicated essential hypertension has no effect on peripheral or hepatic insulin sensitivity.
鉴于胰岛素抵抗与心血管风险相关的证据，比较卡托普利与安慰剂对原发性高血压患者外周和肝脏胰岛素作用的影响。
随机、双盲、安慰剂对照、交叉试验，卡托普利和安慰剂治疗期各8周，前后均有6周的安慰剂洗脱期。
贝尔法斯特教学医院。
从大贝尔法斯特地区的普通诊所招募了18名年龄在65岁以下的白种非糖尿病原发性高血压患者（10名男性）。
卡托普利50毫克，每日两次，或安慰剂每日两次，各进行两个8周的治疗期。
通过葡萄糖钳夹法评估外周和肝脏胰岛素敏感性。
14名患者完成了研究。卡托普利和安慰剂治疗后，空腹血糖、空腹胰岛素和吸收后肝脏葡萄糖生成的平均（±标准误）水平相似（分别为5.4±0.1与5.4±0.1毫摩尔/升、10.6±2.2与9.5±1.1毫国际单位/升、11.2±0.6与11.0±0.5毫摩尔/千克每分钟）。在高胰岛素血症期间，两种治疗后肝脏葡萄糖生成均被抑制到相似水平（4.8±0.6与4.3±0.6毫摩尔/千克每分钟），维持血糖正常所需的外源性葡萄糖输注速率也相似（30.0±2.6与30.3±2.6毫摩尔/千克每分钟）。
卡托普利治疗单纯性原发性高血压对外周或肝脏胰岛素敏感性无影响。
