Diabetes Care:基线舒张压对T2DM患者强化降压获得的心血管结局和全因死亡率的影响

2020-05-05 MedSci原创 MedSci原创

在标准降糖对照者中,无论基线DBP是多少,T2DM患者强化SBP降低都降低了心血管复合终点的风险。因此,在接受指南推荐的标准降糖治疗的T2DM患者中,较低基线DBP不应成为强化SBP降低的障碍。

近日,糖尿病领域权威杂志Diabetes Care上发表了一篇研究文章,该研究旨在评估较低的基线舒张压(DBP)是否能改善强化降低收缩压(SBP)对2型糖尿病(T2DM)患者心血管结局的影响。

糖尿病患者血压控制试验(ACCORD BP)的一项2*2因子随机对照试验,探究了SBP(<120 vs. <140 mmHg)和血糖(HbA1c<6% vs. 7.0-7.9%[<42 vs. 53-63 mmol/mol]控制对T2DM患者(N=4731)心血管事件的影响。研究人员评估了基线DBP和血糖控制是否能改变SBP控制对心血管复合事件的影响。

在标准降糖组中,强化SBP降低可降低心血管复合事件的风险(风险比[HR]为0.76 [95%CI为0.59-0.98]),但在强化降糖组中则无此效应(HR为1.06 [95%CI为0.81–1.40] )。样条回归模型评估了各个范围的基线DBP均参与了干预对心血管复合事件的影响,但在标准或强化降糖治疗组中并未发现通过较低基线DBP对心血管复合事件产生效应修饰的证据。强化SBP干预效果与基线DBP之间的关系在各血糖控制组之间相似(P=0.83)。

由此可见,在标准降糖对照者中,无论基线DBP是多少,T2DM患者强化SBP降低都降低了心血管复合终点的风险。因此,在接受指南推荐的标准降糖治疗的T2DM患者中,较低基线DBP不应成为强化SBP降低的障碍。

原始出处:

Olesya L. Ilkun,et al.The Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Blood Pressure Lowering on Cardiovascular Outcomes and All-Cause Mortality in Type 2 Diabetes.Diabetes Care.2020.https://doi.org/10.2337/dc19-2047

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