Abstract: Objective　To explore the effects of two balanced dietary patterns with different breakfasts on the blood glucose and blood pressure in middle-aged and elderly hypertensive patients with abnormal blood glucose，and to identify the possible mechanism.Methods　We conducted this test from May 23rd to July 1st，2017.According to the inclusion and exclusion criteria，we enrolled 24 hypertensive cases with abnormal blood glucose from the database of middle-aged and elderly hypertensive villagers of Zhangfang Village of Beijing's Fangshan District and randomized them into group A and group B with 12 cases in each.Both groups received a 4-week balanced diet intervention with the same lunch and dinner but different breakfasts except on the 1st day（T0）and 28th day（T4）of intervention，they ate the same breakfast that we used for OGTT：during the second day to the 27th day of intervention，group A ate steamed bread but group B ate anti-atherosclerotic powdered food，along with a cooked egg，the same amount of milk and salad，for breakfast.We collected their sociodemographic characteristics，and the data regarding fasting blood glucose（FBG）and 2 h-postprandial plasma glucose（2 h PG）after breakfast measured at T0，T1（on the 7th day of intervention），T2（on the 14th day of intervention），T3（on the 21st day of intervention）and T4，2 h PG after lunch measured at T1 and T3，systolic blood pressure（SBP），diastolic blood pressure（DBP），fasting insulin（FIN），angiotensin Ⅱ（AngⅡ），malondialdehyde（MDA），total antioxidant capacity（TAC），Ghrelin and adiponectin（ADPN）measured at T0，T2 and T4.Results　The method and duration of intervention produced interaction effects on 2 h PG after breakfast（P<0.05）instead of FBG（P>0.05）.Intervention duration exerted significant main effects on FBG and 2 h PG after breakfast（P<0.05），but the method of intervention did not（P>0.05）.For more detail，the FBG level at T4 was lower than that at T0，T1，T2，T3 in both groups（P<0.05）.The 2 h PG level after breakfast was lower in group B than that of group A at T1，T2，T3（P<0.05）.Group B showed higher 2 h PG level after breakfast at T0 compared with at T1，T2，T3（P<0.05）.Both groups showed similar 2 h PG level after lunch either at T1 or T3（P>0.05）.2 h PG level after lunch at T1 was similar to that at T3 in both groups（P>0.05）.The method and duration of intervention had interaction effects on TAC（P<0.05）but not on SBP，DBP，FIN，AngⅡ，MDA，Ghrelin and ADPN（P>0.05）.The main effect of the intervention method on SBP，DBP，FIN，AngⅡ，MDA，TAC，Ghrelin and ADPN was not significant（P>0.05）.The main effect of intervention duration on SBP，DBP，TAC，Ghrelin，and ADPN was significant（P<0.05），but that on FIN，AngⅡ and MDA was not（P>0.05）.For more detail，for group A，at T4，SBP，DBP and Ghrelin were lower but TAC and ADPN were higher compared with at T0（P<0.05），and TAC was also higher than that at T2（P<0.05）.For group B，SBP was lower and TAC was higher at T2 compared with at T0（P<0.05），when at T4，SBP，DBP and Ghrelin were lower and ADPN was higher compared with at T0（P<0.05），and TAC was lower compared with at T2（P<0.05）.Conclusion　A balanced dietary pattern helps to achieve glycemic and hypertension control for middle-aged and elderly hypertensive patients with abnormal blood glucose，and its effect（for improving overall health）became better when supplemented by anti-atherosclerotic powdered food.The mechanism may be related to improved postprandial glycemic control，increased TAC and ADPN as well as decreased Ghrelin brought by anti-atherosclerotic powdered food.

Key words: Hypertension, Blood glucose, Diet therapy

摘要： 目的　探讨不同早餐形式的均衡膳食干预对中老年高血压合并血糖异常患者血糖和血压的影响，并对可能机制进行探讨。方法　2017-05-23至2017-07-01，根据纳入与排除标准，从北京市房山区张坊村中老年高血压数据库人群中选取高血压合并血糖异常患者24例为研究对象。采用随机数字表法将其分为A组和B组，各12例。A组和B组第1天（T0）及第28天（T4）早餐均为口服葡萄糖耐量试验（OGTT）早餐，第2~27天分别食用馒头早餐和抗动脉粥样硬化食疗粉早餐，所有午餐和晚餐完全相同，干预时间为4周。收集患者一般资料，记录T0、第7天（T1）、第14天（T2）、第21天（T3）、T4时空腹血糖（FBG）、早餐后2 h血糖，T1、T3时午餐后2 h血糖，T0、T2、T4时收缩压、舒张压、空腹胰岛素（FIN）、血管紧张素Ⅱ（AngⅡ）、丙二醛（MDA）、总抗氧化能力（TAC）、饥饿激素（Ghrelin）、脂联素（ADPN）。结果　干预方法与时间在FBG上无交互作用（P>0.05）；干预方法与时间在早餐后2 h血糖上有交互作用（P<0.05）；干预方法在FBG、早餐后2 h血糖上主效应不显著（P>0.05）；时间在FBG、早餐后2 h血糖上主效应显著（P<0.05）。A组、B组T4时FBG低于同组T0、T1、T2、T3时（P<0.05）。B组T1、T2、T3时早餐后2 h血糖低于A组（P<0.05）；B组T1、T2、T3时早餐后2 h血糖低于T0时（P<0.05）。两组T1、T3时午餐后2 h血糖比较，差异无统计学意义（P>0.05）；A组、B组T3时午餐后2 h血糖与同组T1时比较，差异无统计学意义（P>0.05）。干预方法与时间在收缩压、舒张压、FIN、AngⅡ、MDA、Ghrelin、ADPN上无交互作用（P>0.05）；干预方法与时间在TAC上有交互作用（P<0.05）；干预方法在收缩压、舒张压、FIN、AngⅡ、MDA、TAC、Ghrelin、ADPN上主效应不显著（P>0.05）；时间在收缩压、舒张压、TAC、Ghrelin、ADPN上主效应显著（P<0.05）；时间在FIN、AngⅡ、MDA上主效应不显著（P>0.05）。B组T2时收缩压低于T0时（P<0.05）；A组、B组T4时收缩压、舒张压均低于同组T0时（P<0.05）。A组T4时TAC高于T0、T2时（P<0.05）；B组T2时TAC高于T0、T4时（P<0.05）。A组、B组T4时Ghrelin低于同组T0时，ADPN高于同组T0时（P<0.05）。结论　均衡的膳食模式能够降低中老年高血压合并血糖异常患者的血压、血糖，添加抗动脉粥样硬化食疗粉更有利于控制其餐后血糖，从而可能具有更好地改善机体健康的作用，其机制可能与抗动脉粥样硬化食疗粉具有提高机体抗氧化能力和ADPN，以及降低Ghrelin有关。

关键词: 高血压, 血糖, 膳食疗法