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目的:比较缬沙坦单药和缬沙坦联合氨氯地平对轻中度高血压(EH)患者胰岛素抵抗(IR)的影响。方法:选择110例轻中度EH患者,按随机双盲原则分为三个治疗组,分别接受缬沙坦80mg,QD;缬沙坦160 mg,QD或缬沙坦80mg联合氨氯地平5mg,QD治疗,疗程为8周。测定双盲治疗前后患者的收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)和空腹胰岛素(FINS),计算胰岛素敏感指数(ISI)(ISI=Ln(1/FIN*FBG))。结果:有75例患者符合标准进入了双盲治疗研究。治疗前后三个治疗组SBP和DBP均较基线比较明显下降,以缬沙坦80mg联合氨氯地平5mg组血压下降最明显。联合治疗组与缬沙坦160 mg组,FIN明显下降[(23.76±9.04)VS15.30±6.51],P<0.05)和ISI[(-1.35±0.41)VS(-0.91±0.39)],P<0.05)显著改善;但在缬沙坦单药组(无论是单药还是加量组)没有发现有意义的变化。矫正了血压后,联合治疗组仍保持着这种优势。结论:在轻中度高血压患者缬沙坦联合氨氯地平能更有效的降压和改善EH患者IR。
Objective: To compare the effects of valsartan and valsartan combined with amlodipine on insulin resistance (IR) in patients with mild to moderate hypertension (EH). Methods: A total of 110 mild to moderate EH patients were randomly divided into three treatment groups according to the randomized double-blind principle: valsartan 80 mg, QD, valsartan 160 mg, QD or valsartan 80 mg combined with amlodipine 5 mg, QD treatment, treatment for 8 weeks. The systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) and fasting insulin (FINS) were measured before and after double-blind treatment to calculate the insulin sensitivity index (ISI = 1 / FIN * FBG) . RESULTS: Seventy-five patients were eligible for double-blind treatment. Before and after treatment SBP and DBP in the three treatment groups were significantly lower than the baseline, with valsartan 80mg combined with amlodipine 5mg group the most obvious drop in blood pressure. (P <0.05) and ISI [(- 1.35 ± 0.41) VS (-0.91 ± 0.39)], P (P <0.01) <0.05). However, no significant change was found in the valsartan monotherapy group (either in the single drug or in the dosage group). After the blood pressure was corrected, the combination therapy group still maintained this advantage. CONCLUSIONS: Valsartan combined with amlodipine is more effective in lowering blood pressure and improving IR in EH patients with mild to moderate hypertension.