高血压病伴糖尿病的处理.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重庆20081213

多重危险因素的共同控制Steno-2Study2003,2008RCTof160T2DMptswithmicroalbuminuria强化干预vs常规干预 SBP: 130mmHg Totalcholesterol 175mg% HbA1c: 6.5%InitialFU: 7.8y ExtendedFU: 13.3yNEJM2003;348:383 NEJM2008;358:580

STENO-2STUDY:危险因素的控制IntensiveGroupConventionalGroupSystolicBP↓15mmHg(146?131)↓3mmHg(149?146)LDL-C↓50mg%(133?83)↓11mg%(137?126)HbA1c↓0.5%(8.4?7.9)↑0.2%(8.8?9.0)NEJM2008;358:580

STENO-2STUDY:强化治疗的效果%ReductioninComplicationsWithIntensiveRxat13.3yTotalMortality↓40%(50%vs30%)Cardiovascularevents↓59%(65%vs30%)Proliferativeretinopathy↓55%---Nephropathy↓56%---NEJM2008;358:580

4x↑inDM 2.0x↑inHTN05NEJM2000;342:905DiabetesCare2005;28:31006共同土壤学说:“MetabolicSyndrome”03HTNvsNoHTN DMvsNoDM04HYPERTENSIONANDDIABETES:01PARTNERSINCRIME!02

高血压的发病率INDIABETES%withBP?140/90AllU.S.adults30%DiabeticU.S.adults60%?Type1DM-Normoalbuminuria30%-Microalbuminuria40%-Macroalbuminuria80%?Type2DM-AtDx50%-Microalbuminuria80%-Macroalbuminuria95%NEJM2000;342:905DiabetesCare2005;28:310AmJKidDis2007;49(Suppl2):S74JCardiometabSyndr2006;1:95(86%≥130/80)

高血压增加糖尿病病人的并发症RelativeRiskofComplicationsDiabetesvsNoDiabetes:CVD2.0–4.0ESRD7.0Diabetes??BPvsDiabetesCHD3.0Stroke4.0Retinopathy2.0Nephropathy2.0Neuropathy1.6Mortality2.075%diefromCVDJAMA2004;292:2495KidInternat2000;59:703NEJM2005;352:341

关注焦点“SYSTOLICBP”DiabetesCare1994;17:1247 Lancet2002;360:1903 Hypertension2003;42:1206StrongerpredictorofriskthandiastolicBP:Cardiov