Diabetes Care:合并和不合并2型糖尿病的高血压患者,强化降压怎么样?

2018-06-28 吴星 环球医学

2018年6月,荷兰研究者在《Diabetes Care》发表两项随机试验的汇总分析,考察了合并和不合并2型糖尿病(T2DM)对高血压患者强化降压效果的影响。

2018年6月,荷兰研究者在《Diabetes Care》发表两项随机试验的汇总分析,考察了合并和不合并2型糖尿病(T2DM)对高血压患者强化降压效果的影响。

目的:糖尿病血压-心血管风险控制行动(ACCORD-BP)研究未发现强化降低收缩压(SBP)对合并T2DM的高血压患者的心血管事件具有显著的获益效应,而收缩压干预试验(SPRINT)却发现不合并T2DM的高血压患者具有显著的获益效应。本分析旨在评估T2DM和基线心血管疾病风险对强化降压的治疗效果的影响。

研究设计和方法:汇总ACCORD-BP和SPRINT研究的个体患者数据,并平衡了随访时间。两项研究都将高血压患者随机分配到SBP目标<120mmHg或<140mmHg的组中。首要复合终点包括不稳定心绞痛、心肌梗死、急性心衰卒中心血管死亡。使用Cox成比例风险模型评估强化降压与2型糖尿病和10年心血管风险之间的相互作用。

结果:队列由14094名患者组成,平均年龄66±8.9岁,基线平均SBP为139.5±15.6mmHg,33.6%的患者有T2DM。首要复合终点的风险比为0.82(95% CI,0.73~0.93;P=0.0017)。强化降压与T2DM之间的相互作用不显著(P=0.13)。初级预防的T2DM患者中,10年心血管风险较高,但是该风险不与治疗效果产生相互作用(P=0.84)。

结论:强化降压可能具有相似的有利作用,或可降低合并和不合并T2DM的高血压患者的心血管事件。

原始出处:

Brouwer TF, Vehmeijer JT, Kalkman DN, et.al. Intensive Blood Pressure Lowering in Patients With and Patients Without Type 2 Diabetes: A Pooled Analysis From Two Randomized Trials. Diabetes Care. 2018 Jun;41(6):1142-1148. doi: 10.2337/dc17-1722. Epub 2017 Dec 6.

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    2018-06-30 myqhxwg_84281543

    糖尿病的诊治需要我们系统学习

    0

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    2018-06-28 1ddf0692m34(暂无匿称)

    学习了.长知识

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    2018-06-28 zdvfsadb

    学习了

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