The Level Of Serum True Insulin And C-peptide In Aged Hypertension Patients And The Therapeutic Effect Of Telmisartan

OBJECTIVE: Several lines of study suggest that insulin resistance is related to hypertension,insulin resistance is one cause of hypertension. The Prevalence of hypertension is up to 50% in the elderly patients, which is associated with many metabolic obstacles and target-organ damage. However, the study of the elderly hypertensive patients with insulin resistance are few, There are also differed views on the existence of hyperinsulinemia in the elderly patients. The further study of elderly hypertensive patients and IR have important significance to the Individual treatment of elderly patients with hypertension and early prevention and treatment of a variety of metabolic obstacles and target organ damage. This study was carried out on non-diabetic gerone-hypertensive patients to explore the changes in fasting glucose, serum true insulin,C-peptide, lipid ,uric acid,insulin resistance and pancreatic beta cell function index and the correlation with blood pressure, and to evaluate the therapeutic effect of Telmisartan.METHODS: Fasting blood glucose,True insulin, C-peptide, serum Fasting insulin,C-peptide,blood-fat,blood uric acid, lipids, uric acid and insulin resistance, pancreatic beta cell function index were measured in 20 patients with non-obese elderly patients with hypertension (NHT) ,15 cases of obese elderly patients with hypertension (OHT) and 20 healthy elderly (control group). The hypertension patients take Telmisartan 80 microgram orally per day for four weeks. Blood pressure and those indexes mentioned above were observed before and after treatment with Telmisartan. the difference were analyzed by T test .RESULTS:Three were no obvious differences in age ,sex and fasting plasma glucose among three groups. The blood pressure, triglyceride,cholesterol,LDL-cholesterol,uric acid,true FINS,CP levels, HOMA-IR and and HOMA-islet index of NHT group is were higher than the healthy control group. The blood pressure, triglyceride, cholesterol of OHT group is higher than healthy controls.TC,LDL-cholesterol,uricacid,CP levels,true FINS,HOMA-IR and HOMA-islet index were significantly higher than those in healthy control group and NHT Group.Correlation analysis show that FINS increased with fasting plasma glucose,CP,LDL-C and uric acid,but there was no significant correlation with blood pressure.After four weeks of therapy with Telmisarta in patients with hypertension,blood pressure decreased significantly,Averagely, systolic blood pressure fell 16.5mmHg; diastolic blood pressure 9mmHg in the NHT group, and SBP r decrease 21.45mmHg; DBP 10.13mmHg in the OHT group.The low density lipoprotein-cholesterol,total cholesterol, C-peptide,uric acid,HOMA-IR and and HOMA-islet index decreased obviously in the NHT and OHT groups before and after the treatment.CONCLUSION: Elderly hypertensive patients, especially in obese patients are often associated with hyperlipidemia, hyperuricemia and other metabolism disorders, have suffered insulin resistance and hyperinsulinemia. Telmisarta have not only effectively decrease blood pressure,but also decrease cholesterol, uric acid, insulin,and improve insulin resistance and the function of beta Cell of islet.probably due to insulin resistance and impared function ofβcells of pancreatic islets,and attenuate many cardiovascular and metabolic risk factors.which can lead to hypertension and target organ damage.The mechanism may be related to the excitement of PPARγ. The chemiluminescence method for the determination of serum true insulin, C-peptide levels can accurately reflect the level of insulin resistance and pancreaticβ- cell function in elderly patients with hypertension. The studies also showed that telmisartan,as a new unique the AT1 receptor antagonist of AngII, have the powerful and stable role in lowering blood pressure, but also can improve IR, which is expected to be a new treatment for patients with elderly hypertension and obesity hypertension.