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首页> 外文期刊>Advanced studies in medicine >Prevention of type 2 diabetes: Role of the renin-angiotensin-aldosterone system and antihypertensive therapy
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Prevention of type 2 diabetes: Role of the renin-angiotensin-aldosterone system and antihypertensive therapy

机译：预防2型糖尿病：肾素-血管紧张素-醛固酮系统的作用和降压治疗

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摘要

PURPOSE: To review the association between hypertension and insulin resistance, and investigate the effects of renin-angiotensin-aldosterone system (RAAS) inhibition on insulin sensitivity. EPIDEMIOLOGY: Hypertension and diabetes are established risk factors for cardiovascular disease (CVD). In the United States, CVD accounts for 39% of all deaths and affects an estimated 20% of the population. Hypertension is associated with insulin resistance and often occurs in patients with type 2 diabetes mellitus (DM2). The metabolic syndrome is an important clinical clustering of risk factors that suggests overlap between the disease pathways involved in hypertension and diabetes. REVIEW SUMMARY: Early recognition of metabolic syndrome components and intervention is important to reduce adverse cardiovascular outcomes. The risk factors that cluster in this syndrome probably share a common pathway. Inhibition of the RAAS reduces the risk of new-onset DM2. Clinical trials reveal that different classes of antihypertensive agents have different effects on development of new-onset DM2. Thiazide diuretics and β-blockers are associated with increased risk of DM2 whereas agents that block the RAAS may increase insulin sensitivity and significantly reduce the risk of DM2. RAAS-inhibiting agents may produce this beneficial effect through diverse mechanisms, including the effects of these agents on skeletal muscle, adipocyte differentiation, insulin signaling pathways, and protection of pancreatic islet cells. TYPE OF AVAILABLE EVIDENCE: Prospective cohort studies, randomized controlled trials, nationally recognized treatment guidelines, systematic reviews. GRADE OF AVAILABLE EVIDENCE: Good. CONCLUSION: The effects of antihypertensive agents on improving insulin sensitivity and reducing risk of new-onset DM2 should be considered as part of an overall CVD prevention strategy, with RAAS-inhibiting agents demonstrating the most benefit in decreasing the development of new-onset DM2.
机译：目的：探讨高血压与胰岛素抵抗之间的关系，并研究肾素-血管紧张素-醛固酮系统（RAAS）抑制对胰岛素敏感性的影响。流行病学：高血压和糖尿病是确定的心血管疾病（CVD）危险因素。在美国，CVD占所有死亡人数的39％，估计影响着总人口的20％。高血压与胰岛素抵抗有关，常发生于2型糖尿病（DM2）患者中。代谢综合征是重要的临床危险因素聚类，表明与高血压和糖尿病有关的疾病途径之间存在重叠。综述：代谢综合征成分的早期识别和干预对于减少不良心血管预后很重要。聚集在该综合征中的危险因素可能具有共同的途径。抑制RAAS可降低新发DM2的风险。临床试验表明，不同类别的降压药对新发DM2的发展有不同的影响。噻嗪类利尿剂和β受体阻滞剂与DM2风险增加有关，而阻断RAAS的药物可能会增加胰岛素敏感性并显着降低DM2风险。 RAAS抑制剂可通过多种机制产生这种有益效果，包括这些试剂对骨骼肌，脂肪细胞分化，胰岛素信号通路和胰岛细胞保护的作用。可用的证据类型：前瞻性队列研究，随机对照试验，国家认可的治疗指南，系统评价。可用的证据等级：很好。结论：降压药对改善胰岛素敏感性和降低新发DM2风险的作用应被视为整体CVD预防策略的一部分，其中RAAS抑制剂在减少新发DM2的发展中显示出最大的益处。

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