[Incidence of metabolic disorders in patients with essential hypertension and patients with primary aldosteronism].

OBJECTIVE: To compare the incidence of metabolic disorders (MS) in patients with primary aldosteronism (PA) and essential hypertension (EH). METHODS: MS prevalence was observed in 200 EH patients (male 104) and 220 PA patients (male 117) hospitalized to our hospital from August 2005 to March 2007. RESULTS: (1) The prevalence of MS in PA group was significantly higher than that of EH group (47.3% vs. 31.5%, P = 0.009). (2) Blood pressure was significantly higher in PA group than that of EH [SBP: (150.67 +/- 15.45) mm Hg vs. (145.69 +/- 17.13) mm Hg, P = 0.042; DBP: (93.03 +/- 10.51) mm Hg vs. (85.83 +/- 14.44) mm Hg, P = 0.037]. (3) Incidences of abdominal obesity (86.8% vs. 78.5%, P = 0.024) and insulin resistance (insulin sensitivity index: 42.42 +/- 16.11 vs. 49.58 +/- 22.43, P = 0.008) were significantly higher in PA group than in EH group. CONCLUSION: The prevalence of MS in hospitalized PA patients was significantly higher than that of EH patients characterized by prevalent abdominal obesity, insulin resistant and severe hypertension.

[Insulin secretion and insulin sensitivity in 1193 inpatients with essential hypertension].

OBJECTIVE: To evaluate the metabolic profiles of insulin secretion and insulin sensitivity in different categories of nondiabetic patients with essential hypertension, we made a retrospecting study in our hospital. METHODS: According to the criteria of WHO and ADA, we calculated the distribution of plasma glucose levels during a 75 g oral glucose tolerance test (OGTT). Nondiabetic subjects with hypertension were classified into the following four groups: (1) normal glucose tolerance (NGT) with fasting plasma glucose (FPG) < 6.1 mmol/L and 2h-plasma glucose (2hPG) < 7.8 mmol/L, (2) Isolate impaired fasting glucose (IFG) with FPG 6.1-7 mmol/L and 2hPG < 7.8 mmol/L, (3) Isolate impaired glucose tolerance (IGT) with FPG < 6.1 mmol/L and 2hBG 7.8-11.1 mmol/L, (4) impaired fasting glucose and impaired glucose tolerance (IFG/IGT) with FPG 6.1-7 mmol/L and 2hBG 7.8-11.1 mmol/L. Then we divided the groups of NGT and IGT based on the normal 30 or 60 minute plasma glucose level during OGTT respectively. 30 minute plasma glucose level < 11.1 mmol/L and 60 minute plasma glucose level < 10.5 mmol/L were considered to be normal. HOMA-IR (insulin resistance) and composite ISI (insulin sensitivity index) were used to estimate insulin resistance and HOMA-beta and DeltaI/DeltaG index to estimate insulin secretion. RESULTS: 11.1% of the 1193 subjects were newly diagnosed diabetic patients, in whom 57.9% had isolated postchallenge hyperglycemia only. In the IGT and IFG/IGT groups, HOMA-IR were significantly higher than that in the NGT group, whereas composite ISI and DeltaI/DeltaG were significantly lower than that in the NGT group. Whether 30 or 60 minute plasma glucose level was high or not, composite ISI in IGT group was significantly lower than that in the NGT group. In the NGT group, DeltaI/DeltaG in subjects with high 30 or and 60 minute plasma glucose level was significantly lower than that in subjects with normal 30 and 60 minute plasma glucose level. CONCLUSIONS: Subjects with IGT or IFG/IGT have both impaired insulin sensitivity and insulin secretion. In the NGT group, subjects with high 30 or/and 60 minute plasma glucose level have impaired beta-cell function.

Relation of renin-angiotensin system gene polymorphisms and expressions with the efficacy of antihypertensive drugs.

OBJECTIVE: To investigate the relation of renin-angiotensin system (RA3) gene polymorphisms and expressions with the clinical efficacy of antihypertensive drugs. METHODS: This randomized, single-blind study consisted of 90 patients with essential hypertension, who were divided into losartan, lisinopril and nisodipine groups with corresponding medications as indicated. The genotypes of angiotensin-converting enzyme (ACE) insertion/deletion, angiotensinogen (AGT) M235T polymorphism and expressions of ACE and AT1 receptor genes were examined individually. RESULTS: The basal level of mRNA expression of AT1 receptor was lower in patients with MM genotype of AGT gene than those in patients with MT 1 and TT genotypes, but between the latter two, no significant differences were found. The three antihypertensive drugs, when significantly lowering the blood pressure, reduced AT1 receptor mRNA expression concurrently. Losartan and lisinopril both decreased ACE mRNA expression levels that were positively correlated with the difference of the diastolic blood pressure whereas nisodipine elevated ACE mRNA expression, showing inverse correlation to the difference of thediastolic blood pressure. CONCLUSION: For patients with hypertension who have elevated basal levels of AT1 mRNA expression and AGT T allele or who retain high basal expression levels of ACE mRNA AT1 antagonists and ACE inhibitors that execute their action through RAS are preferentially selected, and in cases of low basal levels of ACE mRNA calcium antagonists are preferred.