Metabolik sendromu bulunan hipertansif hastalarda telmisartan tedavisinin insülin direnci, metabolik parametreler ile serum adiponektin ve tümör nekrozis faktör-alfa düzeyleri üzerine olan etkisi
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Date
2009
Authors
Kıyıcı, Sinem Küçüksaraç
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Publisher
Uludağ Üniversitesi
Abstract
Çalışmamızda diyet ve egzersizden oluşan yaşam tarzı değişikliklerine ek olarak 8 haftalık 80 mg/gün dozunda telmisartan (Pritor / GlaxoSmithKline) kullanımının metabolik sendromlu hipertansif hastalarda vücut yağ oranı, arteryal kan basıncı, insülin direnci, glukoz ve lipid metabolizmaları, serum adiponektin ve TNF-a düzeyleri üzerine olan etkileri araştırıldı. Çalışmaya 18'i telmisartan, 18'i kontrol gurubu olmak üzere metabolik sendrom ve hipertansiyon tanısı bulunan toplam 36 hasta alındı. Çalışma sonunda bazal ölçümlere göre her iki gurubun beden kitle indekslerinde, vücut yağ oranlarında ve bel çevrelerinde anlamlı azalma olduğu saptandı. Her iki gurup karşılaştırıldığında telmisartan gurubunda, sistolik ve ortalama kan basıncındaki düşmenin sadece yaşam tarzı değişiklikleri uygulanan kontrol gurubuna göre daha fazla olduğu görüldü (sırasıyla p=0,0001 ve p=0,003). Telmisartan gurubunda kontrol gurubuna göre serum insülin düzeyinde ve HOMA ile belirlenen insülin direncinde anlamlı azalma saptanırken (sırasıyla p=0,040 ve p=0,034) her iki gurubun lipid profilinde istatistiksel anlamlı bir değişiklik gözlenmedi. Serum adiponektin düzeylerinde telmisartan gurubunda % 19,1 ± 41,7 bir artış gözlenmesine rağmen kontrol gurubuna göre istatistiksel anlamlı bir farklılık saptanmadı. Serum TNF-a düzeyleri açısından da her iki gurup arasında anlamlı farklılık yoktu. Sonuç olarak metabolik sendromlu hipertansif hastalarda telmisartan kullanımının yaşam tarzı değişikliğine göre insülin direnci ve glukoz metabolizması üzerine olumlu katkısı olduğu görüldü. Telmisartan kullanımı ile insülin direncinde anlamlı azalma sağlanmış olmasına rağmen adiponektin ve TNF-a düzeylerinde değişiklik gözlenmemiş olması, telmisartan tedavisinin insülin direnci üzerine erken dönemde saptanan etkilerinin PPAR- Y aktivasyonu dışında başka mekanizmalar üzerinden gerçekleştiğini düşündürmektedir. Telmisartan tedavisinin sekiz hafta gibi kısa bir sürede insülin direncinde azalma sağlamış olması metabolik sendromun bir parçası olarak karşımıza çıkan hipertansiyon tedavisinde telmisartan kullanımını iyi bir seçenek haline getirmektedir
In present study, we investigated the effect of 80 mg/day telmisartan usage (Pritor / GlaxoSmithKline) for 8 weeks in addition to life style changes such as diet and exercise on percentages of body fat, arterial blood pressure, insulin resistance, glucose and lipid metabolism, serum adiponectin and TNF-a levels in hypertensive patients with metabolic syndrome. A total of 36 hypertensive patients with metabolic syndrome were enrolled the study and randomized to telmisartan (n=18) and control (n=18) groups. There was significant decrease in body mass indexes, percentages of body fat and waist circumferences according to baseline measurements in both groups at the end of the study. There was a more pronounced decrease in systolic and diastolic blood pressure in telmisartan group compared with control group in which only life style changes were applied (p=0.0001 and p=0.003, respectively). In comparison to control group, serum insulin level and insulin resistance assessed by HOMA-IR were decreased significantly in telmisartan group (p=0,040 and p=0,034, respectively), while there was no statistically significant change in lipid profiles of groups. Serum adiponectin level was increased 19.1 ± 41.7% in telmisartan group but it was not statistically significant compared with control group. There was also no significant change in serum TNF-a level in both groups. In conclusion, it has been observed that telmisartan treatment had favorable effects on insulin resistance and glucose metabolism compared with life style changes. Amelioration of insulin resistance with telmisartan treatment, while there was no change in serum adiponectin and TNF-a levels, indicates that the early effect of telmisartan therapy on insulin resistance is caused by mechanisms other than PPAR-gamma activation. The fundamental effect of short term telmisartan treatment such as 8 weeks on insulin resistance makes telmisartan a good therapeutic option for hypertensive patients with metabolic syndrome.
In present study, we investigated the effect of 80 mg/day telmisartan usage (Pritor / GlaxoSmithKline) for 8 weeks in addition to life style changes such as diet and exercise on percentages of body fat, arterial blood pressure, insulin resistance, glucose and lipid metabolism, serum adiponectin and TNF-a levels in hypertensive patients with metabolic syndrome. A total of 36 hypertensive patients with metabolic syndrome were enrolled the study and randomized to telmisartan (n=18) and control (n=18) groups. There was significant decrease in body mass indexes, percentages of body fat and waist circumferences according to baseline measurements in both groups at the end of the study. There was a more pronounced decrease in systolic and diastolic blood pressure in telmisartan group compared with control group in which only life style changes were applied (p=0.0001 and p=0.003, respectively). In comparison to control group, serum insulin level and insulin resistance assessed by HOMA-IR were decreased significantly in telmisartan group (p=0,040 and p=0,034, respectively), while there was no statistically significant change in lipid profiles of groups. Serum adiponectin level was increased 19.1 ± 41.7% in telmisartan group but it was not statistically significant compared with control group. There was also no significant change in serum TNF-a level in both groups. In conclusion, it has been observed that telmisartan treatment had favorable effects on insulin resistance and glucose metabolism compared with life style changes. Amelioration of insulin resistance with telmisartan treatment, while there was no change in serum adiponectin and TNF-a levels, indicates that the early effect of telmisartan therapy on insulin resistance is caused by mechanisms other than PPAR-gamma activation. The fundamental effect of short term telmisartan treatment such as 8 weeks on insulin resistance makes telmisartan a good therapeutic option for hypertensive patients with metabolic syndrome.
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Keywords
Telmisartan, Metabolik sendrom, İnsülin direnci, Adiponektin, TNF-a, Metabolic syndrome, Insulin resistance, Adiponectin
Citation
Kıyıcı, S. K. (2009). Metabolik sendromu bulunan hipertansif hastalarda telmisartan tedavisinin insülin direnci, metabolik parametreler ile serum adiponektin ve tümör nekrozis faktör-alfa düzeyleri üzerine olan etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.