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目的 分析高血压病伴代谢综合征人群新发糖尿病的预测因素,同时评价较理想的降压药物以降低危险因素,防止糖尿病发生。方法 用随机平行对照临床试验,选轻、中度高血压病患者符合下列 3项中 2项者进入研究: (1)腰围及(或)体质脂数(BMI)异常; (2)甘油三酯(TG)及(或 )低高密度脂蛋白胆固酯(HDL C)升高; (3)糖耐量异常 (IGT)。将患者分成三个干预治疗组: (1)吲哒帕胺+福辛普利组 (第 1组,n=151); (2)阿替洛尔 +尼群地平组 (第 2组,n=160); (3)阿替洛尔+尼群地平+二甲双胍组(第 3组,n=152)。每月随访 1次,按血压水平调整剂量。每 6个月测定空腹血糖及服 75g葡萄糖 2h后血糖,发现异常者定为新发糖尿病而终止试验。在最后随访时重复测定糖耐量试验(OGTT)、胰岛素释放试验(InRT)、血脂、体重及腰围。结果 (1)在三组降压幅度相似(P>0 05)的基础上,新发糖尿病共 23例,三组分别为 10例, 8例, 5例。虽然加服二甲双胍组比不加组新发人数较少但差异未达统计学意义; (2)从三组危险因素构成比看, 第 2、3组,TG升高者在治疗后,分别下降 14 7%及 9 3% (P<0 05),向心性肥胖分别减少 16 7%及 15 9% (P<0 05 ),IGT分别减少 6 6%及 29 6% (P<0 05),而第 1组服药后均无明显变化; (3)平均随访 1年 5个月后基础状态危险因素 (
Objective To analyze the predictors of new-onset diabetes in hypertensive patients with metabolic syndrome, and to evaluate the ideal antihypertensive drugs to reduce the risk factors and prevent the occurrence of diabetes mellitus. Methods Randomized controlled clinical trials were conducted to select patients with mild to moderate hypertension who met the criteria of two of the following three items: (1) waist circumference and / or body mass index (BMI) abnormalities; (2) triglycerides (TG) and / or low-density lipoprotein cholesterol (HDL C); (3) Impaired glucose tolerance (IGT). Patients were divided into three intervention groups: (1) indapamide + fosinopril (group 1, n = 151); (2) atenolol + nitrendipine (group 2, n = 160); (3) atenolol + nitrendipine + metformin group (group 3, n = 152). Follow-up 1 times a month, according to the level of blood pressure to adjust the dose. Fasting blood glucose was measured every 6 months and 75g of glucose after 2h blood glucose, abnormalities were identified as new onset of diabetes and termination of the test. The glucose tolerance test (OGTT), insulin release test (InRT), lipids, body weight and waist circumference were repeated at the last follow-up. Results (1) There were 23 cases of new-onset diabetes mellitus on the basis of similar reduction in blood pressure (P> 0.05), 10 cases in each group, 8 cases in 5 cases. (2) According to the proportions of the three groups of risk factors, in the second and third groups, after the treatment, the TG elevated people decreased, but the difference was not statistically significant 14.7% and 93% respectively (P <0.05), and heart-related obesity decreased by 16.7% and 15.9% (P <0.05), while IGT decreased by 6 6% and 29 6% The first group after taking no significant changes; (3) average follow-up of 1 year and 5 months after the basic state risk factors