高血压病伴糖尿病的处理演示文稿.ppt

* 高血压病伴糖尿病的处理 中国医科大学一院心内科 齐国先 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 Intensive Group Conventional Group Systolic BP ↓ 15 mm Hg (146 ? 131) ↓ 3 mm Hg (149 ? 146) LDL-C ↓ 50 mg% (133 ? 83) ↓ 11 mg% (137 ? 126) HbA1c ↓ 0.5% (8.4 ? 7.9) ↑ 0.2% (8.8 ? 9.0) NEJM 2008; 358:580 STENO-2 STUDY: 强化治疗的效果 % Reduction in Complications With Intensive Rx at 13.3y Total Mortality ↓ 40% (50% vs 30%) Cardiovascular events ↓ 59% (65% vs 30%) Proliferative retinopathy ↓ 55% --- Nephropathy ↓ 56% --- NEJM 2008; 358:580 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 % with BP ? 140/90 All U.S. adults 30% Diabetic U.S. adults 60% ? Type 1 DM - Normoalbuminuria 30% - Microalbuminuria 40% - Macroalbuminuria 80% ? Type 2 DM - At Dx 50% - Microalbuminuria 80% - Macroalbuminuria 95% NEJM 2000; 342:905 Diabetes Care 2005; 28:310 Am J Kid Dis 2007; 49 (Suppl 2):S74 J Cardiometab Syndr 2006; 1:95 (86% ≥ 130/80) 高血压增加糖尿病病人的并发症 Relative Risk of Complications Diabetes vs No Diabetes: CVD 2.0 – 4.0 ESRD 7.0 Diabetes ? ? BP vs Diabetes CHD 3.0 Stroke 4.0 Retinopathy 2.0 Nephropathy 2.0 Neuropathy 1.6 Mortality 2.0 75% die from CVD JAMA 2004; 292:2495 Kid Internat 2000; 59:703 NEJM 2005; 352:341 关注焦点“ SYSTOLIC BP”