The Study On The Effect Of Using Different Antihypertensive Drugs For The Hyperpietic With Impaired Fasting Glucose

Background: In recent years，The relationship between HINS(hyperinsulinemia) andHE(hypertension) is increasingly concerned by people，They found that the FBG（fastinginsulin） is higher than able-bodied person，for they existing IR(insulin resistance).The risingof FINS（fasting insulin）will lead to IFG (impaired fasting glucose)，and the latter be passedfor the precancerous conditions of DM（diabetes mellitus）,also could aggravate IR.All thetime people have been paying attention to the relationship of HE and DM，and founding thetwo parts having the same basis in pathology and physiology—IR. In the near future it hadbeen founded that a part of ARBs (Angiotensin II receptor antagonists) can reduce theIGT(impaired glucose tolerance)to turning DM in a series of research about againsting highblood pressure，will these donot could expound the gains be form the hypotensive ordifference hypotensores，also there were less of the researches about how to intervene the HEcombining IFG’s.Now we have been knowing that IR is when insulin secreting in normal level，thephysiological effect has weaken to stimulate target cell absorbing and using glucose；or fornormal the target cell absorbing and using glucose，needed extra large insulin.In the previousthe study confirmed，IR and hyperinsulinemia could lead to rising of blood pressure，and IR isalso a independent risk factor in cardiovascular，be closely related to the happening、developing、treating and prognosis about hypertens ion and diabetes mellitus[1].Objective：To chose the hyperpietic these also combined by impaired fasting glucose，part to use Losartan Potassium Tablets and the other chouse Levamlodipine Besylate Tabletsall to reduce blood press（BP＜130/80mmHg）during12months，we will watch and contrastthe changes of the supersession and new diabetes mellitus numbers，to prevent or delay thehappen of type2diabetes effectively，also to offer clinical evidence for those part people’searly intervention.Method:1. The200hyperpietic combined by impaired fasting glucose form outpatientservice of Endocrinology department Southwest Hospital， we will introduce the trial objective、procedure and sign the information consent form，furthermore grant each and everyguinea pigs for card to record return visit.2.All patients need to record the w（body mass）and h（heigh）with the same standardbefor the study.BMI (body mass index）=W/h~2（kg/m~2）.W (waistline) measure：at erectposition using flexible rule take from the costal margin to the middle of the crista.H（hip）measure：take the widest of thighboneiliaca. WHR（Waist-hip ratio）is W/H.After having a restwe take the blood pressure three times by sphygmomanometer measure，then count theaveraging.About10～12hours’abrosia，let them finsh the OGTT（FPG、2hPG）and insulinreleasing test(FINS、2hINS)，the blood fa（tTC、TG、LDL-C、HDL-C），glycated hemoglobin（HbA1c），then do statistic analysis.3. Methods200cases were divided into observation group and control group accordingto registration order (odd numbers is Losartan Potassium group， even numbers isLevamlodipine Besylate group)，Losartan Potassium Tablets（50mg/d）and LevamlodipineBesylate Tablets（2.5mg/d） respectively for them，keeping the blood pressure below130/80mmHg，after treatment for4weeks they had to take double dosages if the bloodpressure not up to scratch，going on detection8weeks they would leave the trial in bad bloodpressure.During treatment every month measure blood pressure and blood glucose andclinical follow-up visit12months，after that compere between the two groups.the indexesinclud BP、FPG、2hPG、FINS、2hINS、TC、TG、LDL-C、HDL-C、HbA1c，and the statisticalcomparison between the two groupsResults:During the therapy，all the patients had been compliance better，been losen tofollow-up three cases， the one from Losartan Potassium group and the other usedLevamlodipine Besylate.At the same time owned by all four cases had been rejected for thebad blood pressure control，one form Losartan Potassium group，three from LevamlodipineBesylate group，those by using double dosage of reatment medicines，after eight weeks theblood pressure donot reach the standard，and had to stop the test to change new treatingregimen.At last there were193cases had finished the treatment:Group A has98cases，GroupB has95cases；the male sex is104，the female sex is89.1.The throng illed by hypertension these combining impaired fasting glucose existingmultiple metabolic disorders:193cases of hyperpietic combining impaired fasting glucosehaving finished this trial，the male sex is104，taking up53.9%，the female sex is89，taking up46.1%.The age was from28to60.The age of patients35～55took up a highest ratioamong these，was68.4%（n=132），the patients’ age above55took up21.2%（n=41）.Thereinto58.5%（n=113）of all patients existed insulin resistance in varying degrees（ISI≥-4.7345），at the same time the overweight and/or fat ones were taken up to63.2%（n=122）in all，the rate of unusual triglyceride and/or high density lipoprotein cholesterol was43.5%（n=84）；2.After12months’ contrasting treated，the changes of every testing index in the twogroups:during12months by using strengthen blood pressure and Life style intervention，theFINS level significantly decreased and ISI significantly increased in the Losartan Potassiumgroup (P<0.05)，the Islet function and insulin resistanceas had been improved；compared withthose in the Levamlodipine Besylate group (P<0.05), in which the FINS level and ISI showedno significant changes before and after treatment (P>0.05). The patients’ blood pressure ofthe two groups decreased significantly after the treatment as compared with those before thetreatment，but compared with each other there were without statistically significant(P>0.05)；before and after being treatment，FPG、2hPG、2hINS、TC、TG、LDL-C、HDL-C、HbA1chad no obvious changes(P>0.05)；3.These are193cases of hyperpietic combining impaired fasting glucose having finishedthis trial，who donot ill by new diabetes，and also the clinical observation will be going on.Conclusion:Form this clinical observation there is a higher proportion ofimpairedfasting glucose in the hyperpietic，this study to survey these patients，and to find that there areexisting many kinds of metabolic disorder，for exeample，IR、fat、dyslipidemia et.It shouldbe given the best clinical intervention treatment in the same time of life style intervention(keeping a balanced diet，weight controling，measureing blood pressure、blood fat et),in theearly stage by chosing the preferred plan to intervene treatment，for the diabetes preventing，and also to reduce the risk in forward angiocardiopathy.In common using antihypertensivedrugs，ARB medication(Losartan Potassium)is effect in improving the insulin resistance，increasing insulin sensitivity，better than CCB medication(Levamlodipine Besylate)in thetherapeutic effect，so this kind of antihypertensive is beneficial for the researchers，butbecause of short observation time and less of cases，the new diabetes had beennot observed，it need to further research.