Determination Of Serum Adiponectin Levels In Essential Hypertension And Its Intervention

Objective The level of adiponectin (APN) and the correlation between APN level and metabolic syndrome(MS) were studied in essential hypertension(EH), identifying hypoadiponectinemia exsist in the essential hypertension, providing new ideas for prevention and treatment of EH and MS;Angiotensin converting enzyme inhibitor(ACEI) improves insulin resistance, raises the level of APN by influencing rennin-angiotensin system(RAS) and kallikrein-kinin system(KKS).Methods In the investigation, 33 simple essential hypertension patients without incorporated metabolic syndrome (simple EH group), 42 essential hypertension incorporated metabolic syndrome patients (HMS group) and 30 normal adults were selected according to inclusion criteria, totally including 75 EH patients(simple EH group+ HMS group). Levels of APN, AgⅡand BK in human serum were quantified using specific enzyme-linked immunosorbent (ELISA) assays. Radioimmunoassay were used to determine fasting insulin(FINS), insulin resistance (IR) level was assessed by insulin sensitivity index (ISI). Triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and fasting plasma glucose (FPG) were determined by clinical standard biochemical method. Systolic blood pressure (SBP), diastolic blood pressure (DBP), height (H), weight (W), waist circumference (WC) were studied as well. The APN levels were compared in hypertension patients and normal controls, hypertension patients with incorporated MS group and without incorporated MS group were also studied. Correlations between APN and angiotensinⅡ(AgⅡ), bradykinin(BK), and the index of MS were studied by means of pearson correlation coefficients to understand these factors effect on APN level. Important risk factors that impact APN level were determined by multiple linear regression. After four weeks treatment, the indicators above were detected again. By comparing APN, AgⅡ, BK, ISI and the correlations between APN and other three index after treatment of different doses, we could find out that ACEI improves insulin resistance, raises the level of APN by influencing RAS and KKS.Result①In healthy group, EH group and HMS group, the level of APN, BK and ISI decreases gradually, AgⅡraise gradually (P<0.05).②The APN levels and ISI gradually decreased with elevated blood pressure (P<0.05).③In the EH group, there were significant negative correlations between APN and AgⅡ, DBP, TG, FPG; there were significant positive correlations between APN and BK, ISI, HDL-C(P<0.05). Multiple regression analysis find out that AgⅡ, HDL, DBP is the impact of important factors for APN level.④In HMS group, there were significant negative correlations between APN and AgⅡ, DBP, there were significant positive correlations between APN and HDL-C(P<0.05). Multiple regression analysis find out that AgⅡ, DBP, HDL-C is the impact of important factors for APN level.⑤In the EH group, there were significant negative correlations between ISI and AgⅡ, BMI, DBP, TG, FPG, FINS; there were significant positive correlations between APN and BK, HDL-C(P<0.05). Multiple regression analysis find out that AgⅡ, BK, FPG, FINS is the impact of important factors for ISI.⑥The level of APN, AgⅡand BK raised, AgⅡsteped down after treatment with Enalapril Maleate of 10mg dose and 20mg dose(P<0.05).⑦Compared with the 10mg group, the changes of APN, AgⅡand ISI were even greater value in the 20mg group of simple EH; the changes of APN, AgⅡ, BK and ISI were even greater value in the 20mg group of HMS(P<0.05).Conclusion Essential hypertension patients have a low APN level, and may reduce with the rise of blood pressure. In essential hypertension patients combined with MS, The APN levels decreased significantly. Furthermore, HDL, blood pressure and AgⅡis the significance risk factors to affect APN. AgⅡand BK are the impact important factors of ISI. Enalaprilmaleate could improves insulin resistance, raises the level of APN by influencing RAS and KKS. Compared to 10mg enalaprilmaleate, 20mg enalaprilmaleate is outstanding in decreasing blood pressure, improving IR and the level of APN.