Combination Therapy in the Prevention of Hypertensive Target ...课件.ppt

HYPERTENSION DIABETES: “A DANGEROUS DUO” Thomas D. Giles, M.D. Louisiana State University Medical School New Orleans, Louisiana METABOLIC SYNDROME DIABETES  HYPERTENSION Thomas D. Giles, M.D. Louisiana State University Medical School New Orleans, Louisiana Top Three Countries for Diabetes Association of SBP and CV Mortalityin Men With Type 2 Diabetes End Point Hazard Ratios Associated With Increase in SBP Metabolic Syndrome: NCEP/ATP III Definition Presence of at least 3 of 5 risk factors: Abdominal obesity Elevated blood pressure Elevated fasting glucose Elevated triglycerides Low HDL-C Prevalence of Obesity among US Adults, 1991 and 2001 Prevalence of Diabetes among US Adults, 1991 and 2001 Metabolic Syndrome Diagnostic Criteria for Diabetes, IFG, and IGT Hypertension Hyperinsulinemia can enhance renal sodium reabsorption and vascular reactivity Angiotensinogen from fat cells can increase angiotensin II and thus blood pressure Both systolic and diastolic blood pressure increase with increasing body mass index Visceral Adiposity:The Critical Adipose Depot Role of Abdominal Adipocytes in Insulin Resistance and Heart Disease Cardiometabolic Syndrome: Tight BP Control vs. Tight Glucose Control UKPDS Mean Blood Pressures CAPPP Study: Results SOLVD: Enalapril Reduces New-Onset Diabetes Risk in CHF Patients SOLVD: Enalapril Reduces Diabetes Risk in CHF Patients With IFG LIFE Study: Results CHARM-Preserved Development of new diabetes ALLHAT: Incidence of New-Onset Diabetes at 4 Years* CONCLUSION Diabetes, the metabolic syndrome and hypertension constitute a particularly dangerous combination as regards cardiovascular morbidity and mortality. The primary therapeutic goal is to reduce blood pressure. The ACE inhibitors and ARBs may have additional properties that warrant their use in diabetes and the metabolic syndrome, whereas thiazide diuretic monotherapy may not. The presence of diabetes further increases the already elevate