高血压伴糖代谢异常优选降压方案(+ESC2010亚组分析).ppt

这个表列的是关于ARB降低新发糖尿病风险的研究，其中关于缬沙坦的研究包括VALUE（缬沙坦抗高血压长期应用评价）、KYOTO HEART研究以及两项大规模回顾性队列研究，这些研究均证实缬沙坦较对照组（氨氯地平、非ARB或氯沙坦）显著降低新发糖尿病风险。此外，SCOPE（坎地沙坦对老年人认知和预后的影响研究）、CHARM、CASE-J、ALPINE、LIFE、TRANSCEND、PRoFESS等研究也证实ARB可较对照组降低新发糖尿病风险。虽然SCOPE、TRANSCEND、PRoFESS等研究p值未达到统计学意义，但显示了有利于ARB的趋势。 在关于缬沙坦的循证研究中，缬沙坦在降低新发糖尿病风险方面均得到阳性结果，说明缬沙坦确实有降低新发糖尿病、改善糖代谢的作用。 Julius et al. Lancet 2004; 363: 2022-2031 Sawada T, et al. Eur Heart J 2009;30(20):2461-9. J Hum Hypertens 2007;21:374-380 Weycker et al. J Clin Hypertens 2007; Suppl A (9):P-448 J Hypertens 2003;21:875– 86. Lancet 2003 362: 759–66. Hypertension. 2008;51:393-398. J Hypertens 2003; 21:1563-1574 Lancet 2002; 359: 995–1003 Lancet 2008; 372: 1174–83 N Engl J Med 2008;359. J. Am. Coll. Cardiol. 2005;46;821-826; HR 0.68 (0.57,0.80) P0.0001 * Wiek Van Gilst * 国内调查表明，糖尿病肾病的总体发病率为47.5%，其中早期糖尿病肾病为34%，临床糖尿病肾病为13.5%。不同类型糖尿病患者糖尿病肾病的发病率不同，1型糖尿病33%～44%发生糖尿病肾病，而2型糖尿病中糖尿病肾病的发生率约为20%。病程在10年以内者有3%并发糖尿病肾病，10～20年者有50%，20年以上者几乎100%患有糖尿病肾病。 * * The MicroAlbuminuria Reduction with Valsartan (MARVAL) study was designed to evaluate the blood pressure (BP)-independent effect of valsartan on urinary albumin excretion rate (UAER) in patients with Type 2 diabetes and microalbuminuria (n=332). Patients were randomly assigned to valsartan 80 mg/day or amlodipine 5 mg/day for 24 weeks. The target BP was 135/85 mmHg. If adequate BP control was not achieved by Week 4, the valsartan or amlodipine dose was doubled. If necessary, 2.5 mg/day bendrofluazide could be added from Week 8 and doxazosin from Week 12 in order to achieve target BP. Valsartan significantly reduced UAER compared with amlodipine (p0.001). The UAER at 24 weeks with valsartan was reduced by 44% from baseline with valsartan but only by 8% with amlodipine. In addition, more patients returned to normoalbuminuria by Week 24 with valsartan (29.9%) compared with amlodipine (14.5%, p0.001). Reference: Viberti G, et al. Microalbuminuria reduction with valsartan in patients with Type 2 diabetes me