Benefits of Tight Blood Pressure Control in Diabetic patients with ...课件.ppt

In VALUE trail, reaching BP control by the 6th month was associated with significant benefits. It also showed that the BP response predicted events and survival already after only 1 month of active treatment. (52) Most studies have confirmed that benefits of antihypertensive tx usually appear in the short term. (33-38, 44) The effectiveness of tight BP control was first shown by the HOT trail. After a mean of 3.8 yrs of f/u, subgroup analysis showed that T2D p’t randomized to a target DBP =80 had a significant reduction of 51% when compared with the target of =90 mmHg. (20) The HOPE study embedded the MICRO-HOPE substudy, which investigated the effects of the addition of an ACEI (10mg/d Ramipril) to the current medical regimen. After a median of 4.5 yrs of f/u, a significant reduction of 25% in primary outcomes was reported, with significant reduction in the risk of MI by 22%, of stroke by 33%, and of CV death by 37%. (44) The ADVANCE study also assessed the effects of ACEI/diurectics. After a mean 4.3 yrs of f/u, the relative risk was significant reduced by 9% for macro and microvascular events. These modest (溫和）reductions are easily explained by the fact that the difference in BP between the two groups was small. (5.6 and 2.2 mmHg for SBP and DBP). Thus, there are unequivocal（毫無疑問的） evidence that in both hypertensive p’t with and without DM, benefits of anti-HTN tx on major CV outcomes usually appear shortly after treatment implementation. On the other hand, with regard to the long-term effects of an initial tx, the evidence is rather limited. Strong data in favor of long-term benefits of an early start of anti-HTN tx come from the Syst-Eur study. In Syst-Eur study, elderly p’t with isolated systolic HTN after 2 yrs of randomized tx with nitrendipinde or placebo were invited. After 4 yrs of f/u ( 6yrs after randomization), p’t with early anti-HTN tx had a significantly greater reduction in the risk of stroke (28%), CV complications (15%), and total mortality (1