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Background: No study to date has evaluated whether multifactorial intervention can prevent diabetic nephropathy in patients with type 2 diabetes mellitus and normoalbuminuria. We evaluated the effect of tightly controlling multiple factors recommended by the American Diabetes Association (ADA) on the development and prevention of diabetic nephropathy in Chinese patients with type 2 diabetes mellitus and normoalbuminuria during a 41?2-year period. Methods: A longitudinal cohort study enrolled 1290 patients with type 2 diabetes and normoalbuminuria who received intensified treatment tomeetthe followingADArecommended goals: hemoglobin A1c (HbA1c), less than 7%; systolicbloodpressure, lessthan130mmHg;diastolicblood pressure, less than80mmHg; low-density lipoprotein cholesterol, lessthan100mg/dL;triglycerides, lessthan150mg/ dL; and high-density lipoprotein cholesterol, greater than 40 mg/dL for men and greater than 50 mg/dL for women. Results: During the study period,211patients (16.4%) developed new-onset microalbuminuria. A significant association was found between the achievement ofADAgoals, including HbA1c level less than 7% (hazard ratio [HR], 0.729;95%confidence interval [CI], 0.553-0.906; P=.03), systolic blood pressure less than 130mmHg(0.645; 0.491- 0.848; P=.002), and high-density lipoprotein cholesterol level greater than 50 mg/dL for women and greater than 40 mg/dL for men (0.715; 0.537-0.951; P=.02) and the development of new-onset microalbuminuria. Conclusions: Diabetic nephropathy can be delayed by tight simultaneous achievement of multiple ADArecommended targets. This multifactorial intervention should be started in patients with diabetes and normoalbuminuria. Arch Intern Med. 2010;170(2):155-161 * Lozano研究试验目的:评估氯沙坦50mg为基础的治疗对患者血压、血糖和蛋白尿的影响。 试验设计:一项为期6个月的多中心、开放前瞻性研究,纳入422名高血压(SBP≥140mmHg, or DBP≥90mmHg)伴有2型糖尿病和微量白蛋白尿(UAE 30-300mg/day)的患者,安慰剂导入期2周后,予以氯沙坦50mg治疗两周,血压未得到控制者给予氯沙坦100mg治疗,仍不理想者可给予氯沙坦50mg/HCTZ 12.5mg。 纳入标准:2型糖尿病患者伴高血压;收缩压≥140mmHg;舒张压≥90mmHg;伴微
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