cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1191Research ArticleМЕТАБОЛИЧЕСКИЙ СИНДРОМ И САХАРНЫЙ ДИАБЕТMETABOLIC SYNDROME AND DIABETES MELLITUSМетаболический синдром и антагонисты рецепторов ангиотензина IIMetabolic syndrome and angiotensin II receptor antagonistsМамырбаеваК. М.MamyrbayevaK. M.Victoria-mychka@yandex.ruМычкаВ. Б.MychkaV. B.Victoria-mychka@yandex.ruСергиенкоВ. Б.SergienkoV. B.Victoria-mychka@yandex.ruЧазоваИ. Е.ChazovaI. E.Victoria-mychka@yandex.ruИнститут клинической кардиологии им. А.Л. Мясникова Российского кардиологического научно-производственного комплекса Росздрава, МоскваMyasnikov Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, State Federal Agency for Health and Social Development, Moscow200720042007624251Copyright © Мамырбаева К.М., Мычка В.Б., Сергиенко В.Б., Чазова И.Е., 20072007Мамырбаева К.М., Мычка В.Б., Сергиенко В.Б., Чазова И.Е.Mamyrbayeva K.M., Mychka V.B., Sergienko V.B., Chazova I.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1191

Цель. Изучить влияние терапии антагонистом рецепторов к ангиотензину II ирбесартаном на артериальное давление (АД), чувствительность тканей к инсулину, показатели углеводного и липидного обменов, состояние перфузии головного мозга (ПГМ) у пациентов с артериальной гипертонией (АГ), метаболическим синдромом (МС) и сахарным диабетов 2 типа (СД-2). Материал и методы. В исследование были включены 20 пациентов только с АГ, 20 пациентов с АГ + МС и 20 пациентов с АГ + СД42. Исходно и через 24 недели терапии ирбесартаном проводились физикальное обследование, измерение массы тела, оценка содержания глюкозы и липидов крови, уровня иммунореактивного инсулина, расчет индекса чувствительности к инсулину в ходе внутривенного инулинмодифицированного теста толерантности к глюкозе. Состояние ПГМ оценивалось методом однофотонной эмиссионной компьютерной томографии с использованием в качестве радиофармпрепарата гексаметиленпропиленаминоксим (HMPAO), меченого in vitro изотопом технеция 99mTc. Результаты. Терапия ирбесартаном оказывала выраженный антигипертензивный эффект: целевого уровня АД достигли 80% пациентов только с АГ, 70% с АГ + МС и 50% с АГ + СД-2. У всех пациентов уменьшилась окружность талии; отмечалось достоверное снижение исходно повышенных уровней глюкозы и липидов крови у пациентов с АГ + МС и АГ + СД42. У больных АГ + МС на фоне терапии ирбесартаном достоверно снизился исходно повышенный уровень инсулина крови, а у пациентов АГ + СД-2 зарегистрировано улучшение нарушенной секреции инсулина. У всех пациентов отмечалось повышение чувствительности к инсулину, но только у больных АГ+ МС оно было статистически значимым. Терапия ирбесартаном привела к увеличению исходно сниженной ПГМ во всех группах больных. Заключение. Ирбесартан наряду с хорошей антигипертензивной эффективностью обладает дополнительными позитивными метаболическими эффектами и органопротективными свойствами.

Aim. To investigate the effects of angiotensin II receptor antagonist irbesartan on blood pressure (BP), tissue insulin sensitivity, carbohydrate and lipid metabolism, cerebral perfusion parameters in patients with arterial hypertension (AH), metabolic syndrome (MS), and Type 2 diabetes mellitus (DM-2). Material and methods. The study included 20 patients with AH only, 20 participants with AH + MS, and 20 individuals with AH + DM-2. At baseline and 24 weeks later, physical examination and measurement of body weight, blood glucose, immune-reactive insulin levels, insulin sensitivity index (intravenous insulin4modified glucose tolerance test) were performed. Cerebral perfusion was assessed by single-photon emission computed tomography with 99mTc-HMPAO. Results. Irbesartan therapy demonstrated good antihypertensive effect: target BP levels were achieved in 80% of AH patients, 70% of AH + MS participants, and 50% of AH + DM-2 individuals. Waist circumference reduced in all participants; blood glucose and lipid levels, initially increased, reduced significantly in AH + MS and AH + CD-2 patients. Blood insulin level, increased at baseline, decreased in AH + MS individuals, and insulin secretion improved in AH + DM-2 patients. Insulin sensitivity improved in all participants, but only in AH + MS it was statistically significant. Irbesartan therapy also improved cerebral perfusion, initially reduced, in all patient groups. Conclusion. Irbesartan demonstrated not only good anihypertensive effectiveness, but also positive metabolic and organo-protective effects.

артериальная гипертензияметаболический синдромсахарный диабетирбесартанarterial hypertensionmetabolic syndromediabetes mellitusirbesartanReferencesИ.Е. Чазова, В.Б. Мычка. Метаболический синдром. Москва «Мedia Medica» 2004.И.Е. Чазова, В.Б. Мычка. Метаболический синдром. Москва «Мedia Medica» 2004.Vague J, Vague P, Tramoni M, et al. Obesity and diabetes. Acta Diabetol Lat 1980; 17: 87-99.Vague J, Vague P, Tramoni M, et al. Obesity and diabetes. Acta Diabetol Lat 1980; 17: 87-99.Dahlof B, Devereux RB, Kjeldsen SE et al. Cardiovascular morbodoty and mortality in the Lozartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002; 359: 995-1003.Dahlof B, Devereux RB, Kjeldsen SE et al. Cardiovascular morbodoty and mortality in the Lozartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol. Lancet 2002; 359: 995-1003.Grassi G, Seravalle G, Dell’Oro R, et al. Comparative effects of candesartan and hydrochlorothiazide on blood pressure, insulin sensitivity, and sympathetic drive in obese hypertensive individu4 als: results of the CROSS study. J Hypertens 2003; 21: 1761-9.Grassi G, Seravalle G, Dell’Oro R, et al. Comparative effects of candesartan and hydrochlorothiazide on blood pressure, insulin sensitivity, and sympathetic drive in obese hypertensive individu4 als: results of the CROSS study. J Hypertens 2003; 21: 1761-9.Julius S, Kjeldsen SE, Webel M, et al. Outcomes in hypertensive patients at high risk of cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004; 363: 2022-31.Julius S, Kjeldsen SE, Webel M, et al. Outcomes in hypertensive patients at high risk of cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004; 363: 2022-31.Mimran A, Ruilope L, Kerwin L, et al. A randomised, doubleblind comparison of the angiotensin II receptor antagonist, irbesartan, with the full dose range of enalapril for the treatment of mild-to-moderate hypertension. J Hum Hypertens 1998; 12: 203-8.Mimran A, Ruilope L, Kerwin L, et al. A randomised, doubleblind comparison of the angiotensin II receptor antagonist, irbesartan, with the full dose range of enalapril for the treatment of mild-to-moderate hypertension. J Hum Hypertens 1998; 12: 203-8.Gaudio C, Ferri FM, Giovannini M, et al. Comparative effects of irbesartan versus amlodipine on left ventricular mass index in hypertensive patients with left ventricular hypertrophy. J Cardiovasc Pharmacol 2003; 42(5): 622-8.Gaudio C, Ferri FM, Giovannini M, et al. Comparative effects of irbesartan versus amlodipine on left ventricular mass index in hypertensive patients with left ventricular hypertrophy. J Cardiovasc Pharmacol 2003; 42(5): 622-8.Stumpe KO, Haworth D, Hoglund C, et al. Comparison of the angiotensin II receptor antagonist irbesartan with atenolol for treatment of hypertension. Blood Press 1998; 7(1): 31-7.Stumpe KO, Haworth D, Hoglund C, et al. Comparison of the angiotensin II receptor antagonist irbesartan with atenolol for treatment of hypertension. Blood Press 1998; 7(1): 31-7.Kassler-Taub K, Litteejohn T, Elliott W, et al. Comperative efficacy of two angiotensin II recepror antagonists, irbesartan and losartan in mild-to-moderate hypertension. Irbesartan/Losartan Study Investigators. Am J Hypertens 1998; 11(4Pt 1): 445-53.Kassler-Taub K, Litteejohn T, Elliott W, et al. Comperative efficacy of two angiotensin II recepror antagonists, irbesartan and losartan in mild-to-moderate hypertension. Irbesartan/Losartan Study Investigators. Am J Hypertens 1998; 11(4Pt 1): 445-53.Pouleur HG. Clinical overview of irbesartan: a new angiotensin II receptor antagonist. Am J Hypertens 1997; 10(12 Pt 2): 318S-24.Pouleur HG. Clinical overview of irbesartan: a new angiotensin II receptor antagonist. Am J Hypertens 1997; 10(12 Pt 2): 318S-24.Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin4receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345: 851-60.Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin4receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345: 851-60.Henriksen EJ, Jacob S, Kinnick TR, et al. Selective Angiotensin II Receptor Antagonism Reduces Insulin Resistance in Obese Zucker Rats. Hypertension 2001; 38(4): 884-90.Henriksen EJ, Jacob S, Kinnick TR, et al. Selective Angiotensin II Receptor Antagonism Reduces Insulin Resistance in Obese Zucker Rats. Hypertension 2001; 38(4): 884-90.Schupp М, J?rgen J, Clasen R, et al. Angiotensin Type 1 Receptor Blockers Induce Peroxisome Proliferator–Activated Receptor-g_ Activity. Circulation 2004; 109: 2054-7.Schupp М, J?rgen J, Clasen R, et al. Angiotensin Type 1 Receptor Blockers Induce Peroxisome Proliferator–Activated Receptor-g_ Activity. Circulation 2004; 109: 2054-7.Fogari R, Mugellini A, Poletti L, et al. Effects of celipropol, irbesartan and lisinopril on insulin sensitivity in non diabetic hypertensive patients. J Hypertens 1999; 17(Suppl. 3): S200-4.Fogari R, Mugellini A, Poletti L, et al. Effects of celipropol, irbesartan and lisinopril on insulin sensitivity in non diabetic hypertensive patients. J Hypertens 1999; 17(Suppl. 3): S200-4.Ferranini E, Natali A, Capaldo B, et al. Insulin resistance, hyperinsulinemia and blood pressure. Role of age and obesity. Hypertension 1997; 30: 1144-9.Ferranini E, Natali A, Capaldo B, et al. Insulin resistance, hyperinsulinemia and blood pressure. Role of age and obesity. Hypertension 1997; 30: 1144-9.Clasen R, Schupp M, Foryst-Ludwig A, et al. PPAR g_- Activating Angiotensin Type-1 Receptor Blockers Induce Adiponectin. Hypertension 2005; 46: 137-43.Clasen R, Schupp M, Foryst-Ludwig A, et al. PPAR g_- Activating Angiotensin Type-1 Receptor Blockers Induce Adiponectin. Hypertension 2005; 46: 137-43.Chandran M, Phillips SA, Ciaraldi T, et al. Adiponectin more than just another fat cell hormone? Diabetes Care 2003; 26: 2442-50.Chandran M, Phillips SA, Ciaraldi T, et al. Adiponectin more than just another fat cell hormone? Diabetes Care 2003; 26: 2442-50.Furuhashi M, Ura N, Higashiura K, et al. Blockade of the renin-angiotensin system increases adiponectin concentrations in patients with essential hypertension. Hypertension 2003; 42: 76-81.Furuhashi M, Ura N, Higashiura K, et al. Blockade of the renin-angiotensin system increases adiponectin concentrations in patients with essential hypertension. Hypertension 2003; 42: 76-81.Scheen AJ, Lef?bvre PJ. Insulin resistance versus insulin deficiency: which one comes first? The old question revisited. In: Di Mario U, Leonetti F, Pugliese G, et al., editors. Diabetes in the New Millennium. New York: Wiley & Sons 2000; 101-13.Scheen AJ, Lef?bvre PJ. Insulin resistance versus insulin deficiency: which one comes first? The old question revisited. In: Di Mario U, Leonetti F, Pugliese G, et al., editors. Diabetes in the New Millennium. New York: Wiley & Sons 2000; 101-13.Kahn SE. The relative contributions of insulin resistance and beta4cell dysfunction to the pathophysiology of Type 2 diabetes. Diabetologia 2003; 46: 3-19.Kahn SE. The relative contributions of insulin resistance and beta4cell dysfunction to the pathophysiology of Type 2 diabetes. Diabetologia 2003; 46: 3-19.

The authors declare that there are no conflicts of interest present.