作者： Bakris G, Calhoun D, Egan B, Hellmann C, Dolker M, Kingma I; orlistat and resistant hypertension investigators.
【摘自】外周血管病雜志, 2002年20卷11期.
【摘要】
目的： 探究對(duì)于血壓控制不佳的肥胖患者，奧利司他聯(lián)合低熱卡的減肥方式與單純飲食控制的減肥方式相比能夠更好地改善血壓。
設(shè)計(jì)： 這是為期1年的前瞻性、隨機(jī)雙盲、安慰劑對(duì)照、多中心試驗(yàn)。比較奧利司他聯(lián)合飲食控制與安慰劑聯(lián)合飲食控制對(duì)于肥胖高血壓患者的血壓改善情況。參與者被隨機(jī)分配到奧利司他組和安慰劑組；所有患者都接受不足600卡的飲食并且來(lái)自脂肪的熱量不超過(guò)30％。記錄體重、血壓、血脂、空腹血糖和胰島素水平。
主要觀察指標(biāo)： 奧利司他組患者減重效果更好（-5.4 ±6.4 對(duì)比 -2.7 ± 6.4 kg, P < 0.001）并且體重指數(shù)降低更大（-1.9 ± 2.3 對(duì)比 -0.9 ± 2.2 kg/m2，P < 0.001）。奧利司他治療組患者相比安慰劑組達(dá)到目標(biāo)減重（其定義為 ≥ 5％的體重（BW））的人數(shù)更多（46% 對(duì)比23％，p < 0.001）。奧利司他治療組患者相比安慰劑組舒張壓下降更大（-11.4 ± 8.3 對(duì)比 -9.2 ± 8.4 mmHg，P = 0.002）。奧利司他治療組患者達(dá)到目標(biāo)舒張壓（BP）（定義為最終舒張壓< 90 mmHg或降低至少10 mmHg）的人數(shù)比例更大（67% 對(duì)比53％，P <0.001）。奧利司他治療組中顯著減少了總膽固醇（P < 0.001）和低密度脂蛋白膽固醇（P = 0.001）且不減少高密度脂蛋白膽固醇（P < 0.005）。奧利司他治療組患者達(dá)到降低30％心血管風(fēng)險(xiǎn)人數(shù)比例更大（36.1%與24.0％，P < 0.04）。
結(jié)論： 聯(lián)合奧利司他的減肥方式相比單純控制飲食的減肥方式能更有效地降低血壓，并最終更大的降低了心血管疾病的風(fēng)險(xiǎn)。
[關(guān)鍵詞] 超重、肥胖、高血壓、脂肪酶抑制劑、奧利司他、減重、抗高血壓藥試驗(yàn)、心血管風(fēng)險(xiǎn)、血脂檢查
【文獻(xiàn)原文】
Orlistat improves blood pressure control in obese subjects with treated but inadequately controlled hypertension
Author: Bakris G, Calhoun D, Egan B, Hellmann C, Dolker M, Kingma I; orlistat and resistant hypertension investigators.
Author Affiliations: Rush University Hypertension/Clinical Research Center, Department of Preventive Medicine, Rush Presbyterian/St. Luke's Medical Center, Chicago, Illinois, USA.
Quote From： J Hypertens. 2002 Nov;20(11):2257-67.
【ABSTRACT】
OBJECTIVE：
To investigate the hypothesis that weight reduction with orlistat plus mild caloric restriction leads to better blood pressure control than diet alone in obese individuals with inadequately controlled hypertension. DESIGN This was a 1-year, prospective, randomized, double-blind, placebo-controlled, multicenter trial of orlistat plus diet versus placebo plus diet in obese hypertensives.
INTERVENTIONS:
Participants were randomized to receive either orlistat or placebo; all received a 600 kcal deficient diet with no more than 30% of calories from fat. Weight and blood pressure, lipid levels and fasting glucose and insulin levels were followed.
MAIN OUTCOME MEASURES:
Patients on orlistat experienced greater weight loss (-5.4 +/- 6.4 versus -2.7 +/- 6.4 kg, P< 0.001) and greater reduction in body mass index (-1.9 +/- 2.3 versus -0.9 +/- 2.2 kg/m2, P<0.001). Target weight loss, defined as > or= 5% body weight (BW), was obtained in more orlistat-treated patients than in the placebo group (46 versus 23%, P<0.001). Diastolic BP decreased more in orlistat-treatedpatients than in the placebo group (-11.4 +/- 8.3 versus -9.2 +/- 8.4 mmHg, P = 0.002). A greater percentage of orlistat-treated patients reached goal diastolic blood pressure (BP), defined as final diastolic BP< 90 mmHg or a reduction of at least 10 mmHg (67 versus 53%, P< 0.001). The orlistat-treated group had significantly greater reductions in total cholesterol ( P<0.001), low-density lipoprotein cholesterol (P = 0.001) and non-high-density lipoprotein cholesterol (P< 0.005) and target 30% cardiovascular risk reduction was obtained in more orlistat-treated patients (36.1 versus 24.0%, P< 0.04).
CONCLUSION:
A weight-loss program with orlistat is more effective than diet alone to lower blood pressure and results in greater cardiovascular risk reduction.
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