(精编)【医学教学课件】糖尿病患之高血壓症.pptVIP

ARB and Renal Disease in Patients With Type 2 Diabetes An Asian perspective from the RENAAL study A total of 252 Asian patients were enrolled in the RENAAL study, which compared losartan to placebo in addition to conventional antihypertensive medications in type 2 diabetic patients with nephropathy. Mean follow-up was 3.2 years. Losartan reduced the risk of the primary composite end point composed of a doubling of serum creatinine, end-stage renal disease, or all-cause mortality in Asian patients by 35% (P = 0.02). No difference between losartan and placebo was observed for the cardiovascular composite outcomes. Losartan reduced the level of proteinuria by 47% (P 0.001) and rate of decrease in renal function by 31% (P = 0.0074). Chan JC, et al Diabetes Care 2004:27:874-879. 中危險層級 超高或高 危險層級 低危險層級 監測血壓與 危險因素 3-6個月 監測血壓與 危險因素 6-12個月 立即藥物治療 收縮壓?140或 舒張壓?90 開始藥物治療 收縮壓?150或 舒張壓?95 開始藥物治療 未超出則 繼續監測 未超出則 繼續監測 高血壓處理對策 生活型態調整 : 戒煙, 減肥, 適酒量, 限鹽, 運動等 依危險因子, 靶器官受損, 與關聯狀況評估危險層級 1999 WHO-ISH HYPERTENSION PRACTICE GUIDELINES FOR PRIMARY CARE PHYSICIANS Classification and Management of BP for adults (JNC7) BP classification SBP* mmHg DBP* mmHg Lifestyle modification Initial drug therapy Without compelling indication With compelling indications Normal 120 and 80 Encourage Prehypertension 120–139 or 80–89 Yes No antihypertensive drug indicated. Drug(s) for compelling indications. ? Stage 1 Hypertension 140–159 or 90–99 Yes Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination. Drug(s) for the compelling indications.? Other antihypertensive drugs (diuretics, ACEI, ARB, BB, CCB) as needed. Stage 2 Hypertension 160 or 100 Yes Two-drug combination for most? (usually thiazide-type diuretic and ACEI or ARB or BB or CCB). *Treatment determined by highest BP category. ?Initial combined therapy should be used cautiously in those at risk for orthostatic hypotension. ?Treat patients with chronic kidney disease or diabetes to BP go