Lancet Dia& Endo:2型糖尿病患者,降糖联合降压治疗——试试10mg达帕格列净

2015-11-25 崔倩 译 MedSci原创

高血压是2型糖尿病患者的常见合并症,也是微血管和大血管疾病的主要危险因素。虽然钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂的降血压效果已经建立,但是还需要给予使用这些药物接受抗高血压治疗的患者指导如何如何应用这些药物。该研究的目的是比较SGLT2抑制剂达帕格列净和安慰剂对于不充分控制的2型糖尿病和高血压患者的血压和血糖效果。在这项双盲,安慰剂对照,3期研究中,参与者来自五大洲16个国家311个中心

高血压是2型糖尿病患者的常见合并症,也是微血管和大血管疾病的主要危险因素。虽然钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂的降血压效果已经建立,但是还需要指导使用这些药物进行抗高血压治疗的患者应该如何应用这些药物。该研究的目的是比较SGLT2抑制剂达帕格列净和安慰剂对于不充分控制的2型糖尿病和高血压患者的血压和血糖效果。

在这项双盲、安慰剂对照的3期研究中,参与者来自五大洲16个国家311个中心的患者。不受控制的2型糖尿病(HbA1c 7.0%–10.5%;53-91 mmol/mol)和高血压(在招募和随机化时收缩压140-165mmHg,舒张压85-105mmHg,通过随机化后一周的动态监测,平均24小时的血压≥130/80 mmHg),这些患者正在接受口服抗高血糖药、胰岛素,或两者皆有,或者加上一种肾素-血管紧张素系统阻滞剂和另外的抗高血压药。使用交互式语音应答系统,研究人员随机分配(1:1)患者接受达帕格列净10mg,每天一次或接受安慰剂,通过在基线时额外使用抗高血压药物和胰岛素进行随机化分层。共同主要终点是在全分析集中,收缩压和糖化血红蛋白的变化,该全分析及包括接受至少一个剂量的研究药物的所有患者,并且他们有基线和至少一个基线后测量效果。

在2010年10月29日和2012年10月4日之间,研究人员随机分配225例患者接受达帕格列净,224例患者接受安慰剂。与安慰剂组相比(-7.62mmHg[-9.72到-5.51];调整安慰剂的达帕格列净差异-4.28mmHg[-6.54至-2.02];P=0.0002),达帕格列净组的收缩压显著减少(从基线调整后的平均变化-11.90mmHg[95%CI -13.97至-9.82])。达帕格列净组患者HbA1C浓度的减少量(从基线-0.63%调整后的平均变化[95%Cl -0.76至-0.50])也比那些分配到安慰剂组的患者(-0.02 %[-0.15到0.12]显著增加;安慰剂调整的差异-0.61%[-0.76至-0.46];P<0.000)。在事后的分析中,研究人员发现接受β受体阻断剂(-5.76mmHg[95%Cl为-10.28至-1.23])或钙通道阻滞剂(-5.13mmHg,[-9.47至-0.79])作为额外的抗高血压药物的患者比那些接受噻嗪类利尿剂(-2.38mmHg[-6.16至1.40] )的患者的血压与安慰剂组相比差异更大。两组的不良事件是相似的(分别为98例[44%] vs 93例[42%],至少有一个不良事件),很少有不良事件涉及到肾功能(1% vs <1%)或容量较少(<1% vs 0%)。

达帕格列净10mg可显著改善血压和糖化血红蛋白,其耐受性与安慰剂类似。其降血压特性对于已经接受β受体阻断剂或钙通道阻断剂的患者特别有利。达帕格列净对于需要利尿的2型糖尿病患者可能有益,可以优化血压控制,对降压药物治疗方案的增加有重要意义。

原始出处:

Michael A Weber,Traci A Mansfield,Valerie A Cain,et al.Blood pressure and glycaemic effects of dapagliflozin versus placebo in patients with type 2 diabetes on combination antihypertensive therapy,Lancet Diabetes & Endocrinology,2015.11.24

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    2017-06-03 卡圣

    学习了,谢谢

    0

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    2016-12-31 1e1cc4c8m47(暂无匿称)

    不错不错

    0

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    2016-11-09 成g

    好好学习咯。

    0

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    2016-11-04 清幽蓝燕yan

    2015年的文章吗?

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=206001, encodeId=792020600149, content=学习了,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOWcPEsEP4FrvDcicue5V6rMkmXmY73KjYP59vQrEdjU89iaN4ZkOhsItlHkmGTjhV3b5S3zOQA4E0/0, createdBy=cc261682151, createdName=卡圣, createdTime=Sat Jun 03 12:33:55 CST 2017, time=2017-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=167038, encodeId=558916e03816, content=不错不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=de852001868, createdName=1e1cc4c8m47(暂无匿称), createdTime=Sat Dec 31 12:45:03 CST 2016, time=2016-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154596, encodeId=127315459625, content=好好学习咯。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/09/ff64516e9d197b1c56322772a5c81df3.jpg, createdBy=2e5d1927752, createdName=成g, createdTime=Wed Nov 09 17:37:31 CST 2016, time=2016-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=153238, encodeId=fd97153238ed, content=2015年的文章吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJHmctib8wsjB1Y0etxU20nsCbR8rZ2fpibp2STmwH2YzicIsTe9oHRGB6XIMeBqNdIvxODicmzfeQibIw/132, createdBy=82211964557, createdName=清幽蓝燕yan, createdTime=Fri Nov 04 07:11:45 CST 2016, time=2016-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=147579, encodeId=7af714e57975, content=学习了,以后要多关注进展。感谢梅斯, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85621649328, createdName=1ddc3547m22(暂无匿称), createdTime=Thu Oct 13 11:01:42 CST 2016, time=2016-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=144080, encodeId=3441144080e0, content=以后多多关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Tue Oct 11 11:38:27 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=144079, encodeId=b19c1440e938, content=学习受益了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Tue Oct 11 11:38:15 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135592, encodeId=71dd1355929f, content=非常有趣的新药,不知道实际疗效如何, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Mon Sep 26 21:13:01 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1828321, encodeId=ac1318283211c, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Tue Mar 22 14:06:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1971758, encodeId=247f19e175817, content=<a href='/topic/show?id=5c2a93925ab' target=_blank style='color:#2F92EE;'>#达帕格列净#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93925, encryptionId=5c2a93925ab, topicName=达帕格列净)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fb6449, createdName=ZGMFX24A, createdTime=Wed May 18 04:06:00 CST 2016, time=2016-05-18, status=1, ipAttribution=)]
    2016-10-13 1ddc3547m22(暂无匿称)

    学习了,以后要多关注进展。感谢梅斯

    0

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    2016-10-11 1e128d2fm65(暂无匿称)

    以后多多关注

    0

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    2016-10-11 1e128d2fm65(暂无匿称)

    学习受益了

    0

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    2016-09-26 1e0a2178m68(暂无匿称)

    非常有趣的新药,不知道实际疗效如何

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=206001, encodeId=792020600149, content=学习了,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo6KcicAVC1MwuOWcPEsEP4FrvDcicue5V6rMkmXmY73KjYP59vQrEdjU89iaN4ZkOhsItlHkmGTjhV3b5S3zOQA4E0/0, createdBy=cc261682151, createdName=卡圣, createdTime=Sat Jun 03 12:33:55 CST 2017, time=2017-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=167038, encodeId=558916e03816, content=不错不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=de852001868, createdName=1e1cc4c8m47(暂无匿称), createdTime=Sat Dec 31 12:45:03 CST 2016, time=2016-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=154596, encodeId=127315459625, content=好好学习咯。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/09/ff64516e9d197b1c56322772a5c81df3.jpg, createdBy=2e5d1927752, createdName=成g, createdTime=Wed Nov 09 17:37:31 CST 2016, time=2016-11-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=153238, encodeId=fd97153238ed, content=2015年的文章吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJHmctib8wsjB1Y0etxU20nsCbR8rZ2fpibp2STmwH2YzicIsTe9oHRGB6XIMeBqNdIvxODicmzfeQibIw/132, createdBy=82211964557, createdName=清幽蓝燕yan, createdTime=Fri Nov 04 07:11:45 CST 2016, time=2016-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=147579, encodeId=7af714e57975, content=学习了,以后要多关注进展。感谢梅斯, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85621649328, createdName=1ddc3547m22(暂无匿称), createdTime=Thu Oct 13 11:01:42 CST 2016, time=2016-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=144080, encodeId=3441144080e0, content=以后多多关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Tue Oct 11 11:38:27 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=144079, encodeId=b19c1440e938, content=学习受益了, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Tue Oct 11 11:38:15 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135592, encodeId=71dd1355929f, content=非常有趣的新药,不知道实际疗效如何, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Mon Sep 26 21:13:01 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1828321, encodeId=ac1318283211c, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Tue Mar 22 14:06:00 CST 2016, time=2016-03-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1971758, encodeId=247f19e175817, content=<a href='/topic/show?id=5c2a93925ab' target=_blank style='color:#2F92EE;'>#达帕格列净#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=93925, encryptionId=5c2a93925ab, topicName=达帕格列净)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fb6449, createdName=ZGMFX24A, createdTime=Wed May 18 04:06:00 CST 2016, time=2016-05-18, status=1, ipAttribution=)]
    2016-03-22 howi
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