高血压病伴糖尿病的处理.pptxVIP

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% HbAlc: 6. 5% -Initial FU: 7. 8y Extended FU: 13.3y;STENO-2 STUDY:危险因素的控制;STENO-2 STUDY: 强化治疗的效果;HYPERTENSION AND DIABETES:;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 ? 65% of DM hypertensives have isolated systolic hypertension ? Systolic hypertension more difficult to control;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?;控制不理想的原因何在? 用药依从性低;改善的策略IN DM-HTN CONTROL ? Educate patients: goal BP, etc ? Control cost ? Dose QD, fixed-combo pills ? Address side effects ? ADHERENCE! ? Decrease clinician therapeutic 惰性 -Q Imo FU, △ Rx until BP 130/80 一 Team care ? home BP monitoring;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;血压类型IN DM;评价 OF HYPERTENSION IN DM;危险分层 初始治疗;Office BP N 130/80 on 2 visits W 1 month apart or Home BP or daytime awake BP by 24-hr ABPM N ----------------------T25/75----------------------;生活方式干预（资料很少）;降压药的选择IN DIABETES;心血管病的预防IN DIABETES Meta-analyses of RCTs for DM-HTN: CHD/Stroke/CVD events: -D = ACE-1 = ARB = CCB -Alpha-blockers, BBs （age〉60y） less effective CHF: -CCBs less effective for prevention -? ARBs, diuretics more effective? -ACEI effective;BBs vs OTHER ANTI-HTN AGENTS;BBs FOR HTN: NEW GUIDELINES Not 1st - line Rx unless HF, post-MI, angina: -AHA, 2007 ? NICE/BHS, 2006 ? CHEP, 2008 and ESC/ESH, 2007 Carvedilol possibly favored over metoprolol: ? Greater | in microalbuminuria ? Lesser f in wt, TG, HbAlc Circulation 2007; 115:2761 Can J Card 2007; 23:529 Eur Heart J 2007; 28:1462 HyDertension 2005; 46:1309 Kid Tntcrnat 2006; 70:1905;LESS EFFECTIVE BP DRUGS: ALPHA-BLOCKERS (Doxazos