| Background:A large number of studies have shown that, impaired fasting glucose(IFG) is a risk factor of predicting the independent of diabetes, people with impaired fasting glucose(IFG) has the significantly higher chance of progressing to diabetes than the general population, and it is the huge reserve crowds of diabetes. Therefore, impaired fasting glucose has attracted the attention of the scholars at home and abroad, the related clinical and basic research has also appears in succession. Epidemiological studies have shown that people with impaired glucose tolerance(IGT) and with impaired fasting glucose(IFG) has only overlapping part of the crowd, and both on the obvious different site in insulin resistance, so to explore the pathogenesis and outcome isolated impaired fasting glucose(i-IFG) in patients has important clinical significance. Evidence-based clinical trails showed that insulin resistance exist in 40% ~ 50% of patients with hypertension, insulin resistance often brings about abnormal blood glucose, in recent years, whether there is a common pathophysiological basis between essential hypertension and diabetes is the focus of research in the domestic and overseas. Although some studies have found that angiotensin receptor antagonists can reduce the risk of diabetes, but they did not illuminate whether it is because the step-down of blood pressure or antihypertensive medication itself, and there is little study on the clinical outcomes and intervention of patients with isolated impaired fasting glucose combined primary hypertension. Therefore, it is important to explore methods to inhibit or reduce the progression of isolated impaired fasting glucose combined essential hypertension into diabetes mellitus, to observe the effect of the hypertension on the outcome of isolated impaired fasting glucose, and to confirm whether the improvement of abnormal blood glucose is caused by anti-hypertensive drugs or the reduction of blood pressure. Our findings should contribute to the effective prevention or delay of type 2 diabetes mellitus in many prediabetic patients.Objective:To observe the relationship of insulin resistance and islet function with blood pressure in patients with isolated impaired fasting glucose, and to observe the effect of anti-hypertensive therapy on insulin resistance and islet function in patients with isolated impaired fasting glucose combined essential hypertension.Research Design and Methods: Experiment of this study is divided into two parts. The first part: 180 patients with isolated impaired fasting glucose were chose, after determination of blood pressure, they were divided into hypertension group(n = 94) and normal blood pressure group(n = 86), healthy lifestyle was carried out in these two groups, hypertension group was given clinical common antihypertensive treatment(Angiotensin Receptor Blockers or Calcium Channel Blockers), compared the changes of fasting blood glucose(FPG), postprandial 2-hour blood glucose(2hPG), fasting insulin(FINS), 2 hours insulin(2hINS), glycosylated hemoglobin(HbA1c) and the homeostasis model of insulin resistance(HOMA-IR) between two groups after 6 months. The second part: 244 patients with primary hypertension with isolated impaired fasting glucose were random(124:120) given losartan potassium tablets(50-100 mg/d) or levamlodipine besylate tablets(2.5-5.0 mg/d) for intensive anti-hypertensive treatment for 3 years with heathy lifestyle interventions at the same time, as blood pressure reach the standard(BP < 130/80mmHg), the changes in fasting plasma glucose, fasting insulin, postprandial 2-hour blood glucose, postprandial 2-hour insulin, glycosylated hemoglobin and insulin sensitivity index(ISI) from before to after treatment were observed.Results:The first part of the result: the fasting insulin, 2 hours fasting insulin and HOMA- IR in patients with essential hypertension(EH) is obviously higher than patients with normal blood pressure at baseline(P < 0.5); both groups were followed up for 6 months, fasting insulin, 2 hours fasting insulin and HOMA-IR in essential hypertension group was significantly decreased contrast with the baseline(P < 0.05), there were 66 essential hypertension patients whose blood pressure reached successful blood pressure control(BP< 130/80 mmHg), and 20 essential hypertension cases whose blood pressure did not get successful controlled; fasting insulin, 2 hours fasting insulin and HOMA-IR in these 66 essential hypertension patients is lower than fasting insulin, HOMA-IR in those 20 essential hypertension cases(P < 0.05); there was no significant change of these indicators was aboserved in normal blood pressure group after 6 months(P > 0.05); The incidence of new-onset diabetes mellitus was not significantly different between two groups.The second part of the result: blood pressure in two groups significantly decreased after treatment than before treatment(P < 0. 05), After 12 months, the fasting insulin and 2 hours fasting insulin in the losartan potassium group was significantly decreased and insulin sensitivity index was significantly improved compared with baseline(P<0.05) and compared with levamlodipine besylate group at the same time(P<0.05). After 24 months and 36 months of treatment, FINS and 2hINS was obviously decreased and ISI was clearly improved in both groups compared with baseline(P<0.05), and no distinctly difference was found between these two groups(P>0.05). The incidence of new-onset diabetes mellitus was not significantly different between two groups.Conclusion:The first part: insulin resistance is very popular in patients with isolated impaired fasting glucose combined with essential hypertension, the population of insulin resistance may be concerned with high blood pressure, successful blood pressure control may ameliorate the insulin resistance and islet function of isolated impaired fasting glucose combined with essential hypertension.The second part: antihypertensive therapy can improve insulin resistance and islet function of patients with isolated impaired fasting glucose associated with essential hypertension. In these two antihypertensive drugs used in the study, losartan potassium may be better in improving insulin resistance and islet function than that of levamlodipine besylate at follow-up of 12 months, but after 24 months and 36 months of follow-up, insulin resistance and islet function were improved significantly in two groups compared with the baseline, and the incidence rate of new diabetes is nto significantly different between two groups, these results suggest that the effects of these two drugs on islet function and insulin resistance are not obviously different... |
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