高血压病伴糖尿病的处理.pptVIP

高血压病伴糖尿病的处理 多重危险因素的共同控制 Steno-2 Study 2003, 2008 RCT of 160 T2DM pts with microalbuminuria 强化干预 vs 常规干预 SBP: 130 mm Hg Total cholesterol 175 mg% HbA1c: 6.5% Initial FU: 7.8y Extended FU: 13.3y NEJM 2003; 348:383 NEJM 2008; 358:580 STENO-2 STUDY: 危险因素的控制 STENO-2 STUDY: 强化治疗的效果 HYPERTENSION AND DIABETES: PARTNERS IN CRIME! 共同土壤学说: “Metabolic Syndrome” HTN vs No HTN DM vs No DM 2.4x ↑ in DM 2.0x ↑ in HTN NEJM 2000; 342:905 Diabetes Care 2005; 28:310 高血压的发病率 IN DIABETES 高血压增加糖尿病病人的并发症 关注焦点“ SYSTOLIC BP” Stronger predictor of risk than diastolic BP: Cardiovascular disease Renal dysfunction 糖尿病伴高血压病的控制达标现状 控制不理想的原因何在？ 疾病本身的原因 Most DM pts need 3-4 drugs to control BP Activation of RAA – system Volume overload, especially if CKD Sleep apnea from associated obesity Vascular damage J Hypertens 2005; 23:2305 Hypertension 2000; 35:1038 Am J Hypertens 2004; 17:915 J Cardiometab Syn 2007; 2:114 控制不理想的原因何在？ 改善的策略 IN DM-HTN CONTROL 诊断 IN HTN IN DIABETES Accurate office BP measurement Out-of-office BP measurement for some Home BP measurement 24-hour ambulatory BP monitor study 诊室血压测量: KEY TECHNIQUES 非诊室 BP MEASUREMENT Recommended for all HTN pts by AHA, 2008 Best predictor of CVD events Detects “white coat” and “masked” HTN 非诊室 BP goals 诊室 BP goal Equivalent Goal BP Office BP 130/80 Home BP 125/75 24-h ABPM study: Daytime awake BP 125/75 Full 24-h BP 120/70 AHA Hypertension Primer, 2008; p.343 血压类型 IN DM 评价 OF HYPERTENSION IN DM 危险分层----初始治疗 Lower CVD risk Initial lifestyle Rx Higher CVD risk Initial drug Rx ? Lifestyle Rx Diabetes Care 2008; 31(Supple 1):S24 生活方式干预（资料很少） 降压药的选择 IN DIABETES Optimal drug(s) for CVD outcomes? 75% of DM pts die from CVD Optimal drug(s) for renal outcomes? 10-20% of DM pts develop