替米沙坦和硝苯地平可以同时吃吗_替米沙坦联合硝苯地平控释片对肥胖性高血压患者的疗效观察
[摘要] 目的 观察替米沙坦联合硝苯地平控释片对肥胖性高血压患者的疗效及对患者血脂和胰岛素抵抗的影响。 方法 选取2010年6月～2011年6月就诊的肥胖性高血压患者190例，随机分为观察组和对照组，两组各95例。对照组予以硝苯地平治疗，观察组在对照组基础上予以替米沙坦治疗。观察两组的疗效、血脂、体重指数（BMI）、空腹血糖（FPG）、空腹胰岛素（FIns）和稳态胰岛素评价指数（HOMA-IR）。 结果 观察组总有效率为92.63%，对照组总有效率为81.05%，观察组总有效率优于对照组，差异有统计学意义（χ2 = 4.606，P = 0.032）。治疗后，观察组的TC、TG、BMI和HOMA-IR较治疗前和对照组明显降低，差异有统计学意义（P ＜ 0.05或P ＜ 0.01）。两组治疗前后的LDL-C、HDL-CFPG和FIns水平差异无统计学意义（P ＞ 0.05）。 结论 替米沙坦联合硝苯地平控释片对肥胖性高血压疗效显著，有降低血脂水平、改善胰岛素抵抗的作用。
[关键词] 原发性高血压；肥胖；血脂；替米沙坦；硝苯地平控释片
[中图分类号] R544.1 [文献标识码] A [文章编号] 1673-7210（2012）07（c）-0080-03
Efficacy of Telmisartan combined with Nifedipine in patients with obesity hypertension
WU Chi
Department of Internal Medicine, Pingliang Health Center of Shanghai Yangpu District, Shanghai 200082, China
[Abstract] Objective To observe the efficacy of Telmisartan combined with Nifedipine in patients with obesity hypertension and its effect on blood lipids and insulin resistance. Methods 190 obese patients with hypertension from June 2010 to June 2011 were randomly divided into observation group and control group, each group was 95 cases. Control group were given Nifedipine, Telmisartan were perfermed on the basis of the control group in observation group. The effect, blood lipids, body mass index (BMI), fasting plasma glucose (FPG), fasting insulin (FIns) and insulin homeostasis assessment index (HOMA-IR) were observed in each group. Results The total effective rate was 92.63% in the observation group, 81.05% in the control group, the difference was statistically significant (χ2 = 4.606, P = 0.032). After treatment, The levels of TC, TG, BMI and HOMA-IR in the observation group were significantly lower than those before treatment and the control group, the differences were statistically significant (P ＜ 0.05 or P ＜ 0.01). The levels of LDL-C, HDL-CFPG and FIns before treatment were not statistically different compared with after treatment (P ＞ 0.05). Conclusion The effect of Telmisartan combined with Nifedipine on blood pressure is very obvious, can decrease the blood lipid and improve the insulin resistance.
[Key words] Hypertension; Obesity; Lipids; Telmisartan; Nifedipine
胰岛素抵抗（insulin resistance，IR）和继发于IR的高胰岛素血症是原发性高血压的独立危险因素，是原发性高血压发生的重要机制之一[1]。近年来，原发性高血压和IR有着密切的联系，故越来越受到学者的关注，血管紧张素转换酶抑制剂（ACEI）可以改善IR[2]，而替米沙坦是否对原发性高血压患者具有改善IR，对血脂是否有影响，本文通过研究，取得了良好的结果，现报道如下：
1 资料与方法
1.1 一般资料
选取2010年6月～2011年6月在我院就诊的肥胖性高血压患者190例，且体重指数（BMI）≥25 kg/m2；收缩压≥140 mm Hg（1 mm Hg=0.133 kPa），舒张压≥90 mm Hg；如为复诊患者，选择未坚持系统治疗，已停用原有降压药物2周以上的患者入组；排除继发性高血压、服用减肥药、降脂药以及排除同时患有严重肝肾肺疾病、恶性肿瘤、免疫性疾病等的患者。通过随机数字的方法将患者分成观察组和对照组，各95例，观察组男64例，女31例，平均年龄（62.84±10.43）岁；对照组男67例，女28例，平均年龄（63.01±10.83）岁。本组研究经医院伦理委员会通过，患者知情同意。两组在年龄、性别、血压和BMI等一般资料方面差异无统计学意义（P ＞ 0.05），具有可比性。