糖尿病合并冠心病的降压药物选择

糖尿病和高血压相互促进、相互影响．且两者均是冠心病的独立危险因素。糖尿病合并冠心病的高血压患者降压尤为重要．虽然循证医学证明现有的四大类降压药物（RAAS阻滞剂、钙离子拮抗剂、β-受体阻滞剂、利尿剂）均可有效降低血压并减少心血管事件的发生．但我们在选择降压药物时除了考虑药物为患者带来的最大的心血管获益外,仍需考虑长期的药物应用对血糖的可能影响。本文就糖尿病合并冠心病的高血压患者如何选择降压药物作一综述。     

糖尿病合并高血压患者的降压药物选择

糖尿病和高血压常合并存在,对心血管系统的危害性较大,易导致脑卒中、心肌梗死、心力衰竭和肾功能衰竭等。对糖尿病合并高血压患者,应基于靶器官损害的程度选择降压药物。本文介绍常用的降压药物及其在糖尿病合并高血压患者治疗中的应用。     

我院糖尿病合并高血压患者降压用药情况分析

目的了解糖尿病伴高血压住院患者常用降压药物的种类和降压治疗方案,为合理治疗提供依据。方法分析调查我院内分泌科确诊为糖尿病伴高血压患者的用药情况,统计分析降压药物的使用及治疗方案。结果 516例患者中,单一药物使用率约44.4%,ARB和CCB为主要单用药;大部分患者降压治疗为2种药物及2种药物以上联合降压(55.6%),ARB+CCB为主导用药。结论我院内分泌科糖尿病合并高血压住院患者降压药物应用种类基本符合JNC-Ⅶ高血压治疗指南,用药基本合理。     

高血压伴2型糖尿病患者降压用药分析

目的分析高血压伴2型糖尿病患者的降压药物使用情况,为临床合理地治疗提供依据。方法参照《中国高血压防治指南（2005年修订版）》,分析调查2012年本院150位高血压伴2型糖尿病住院患者的降压药给药情况,统计分析降压药物的使用情况。结果 150例高血压伴2型糖尿病患者的降压药物使用情况是：使用频次最高的降压药物是Ca2＋通道阻滞剂（CCB）,主要用药方式为二联用药,其次是三联用药。结论医生给高血压伴2型糖尿病患者使用降压药时较为合理。     

糖屎病患者血压控制达标仅三成

由全国157家医院组成的高血压协作组调查发现，我国糖尿病合并高血压的患者血压控制不理想，控制达标率只有31％。该结果说明，我国糖尿病患者血压控制状况并不理想。而医师对“糖尿病患者需要强效降压、尽早达标”的理念认识不足。研究人员呼吁，医师要及时调整治疗方案，尽早控制患者病理性血压升高。糖尿病患者也切忌因为症状缓解或无明显症状就自行减药或停药，同时还要结合低盐饮食、适当体力活动等非药物治疗，强化血压控制，以降低发生心脑血管病的风险及总体死亡率。     

关注高血压合并冠心病风险管理

<正>目前我国约70%的冠心病患者合并高血压,因高血压引起的心血管事件发病/死亡率的相对风险随血压升高而显著增加。日前,中华医学会心血管病学分会和上海勃林格殷格翰药业有限公司共同举办的"2012中国高血压合并冠心病风险管理项目"相继在多个城市启动。这个项目旨在通过使用具有明确降低心血管风险适应症的降压药物,优化高血压合并冠心病的降压治疗方案,提升高血压合并冠心病患者的降压治疗的达标率、减少心血管事件的发生和死亡。     

围术期降压药物应用研究进展

我国居民高血压发生率逐年升高,围术期高血压易引起其他多种心脑血管类并发症,可增加围术期患者死亡的风险。为提高高血压患者围术期的血压达标率及降压药物合理用药提供参考,减轻术后并发症,改善患者的预后水平,降低住院总成本,本文对近几年来国内外关于围术期降压药物的作用机制及各个降压药物应用原则问题进行综述。     

硝苯地平联合厄贝沙坦治疗糖尿病合并高血压的疗效分析

<正>临床中常见的慢性疾病主要有高血压、糖尿病,这两种疾病的发病原因和对患者的危害方面存在共通性,且互为危险因素,两者同时存在时会增加心血管疾病发病风险,病情复杂,病情危害性大[1]。因此,临床治疗时应选择不同作用机制的降压药物、降糖药物以提升疗效。本研究采用硝苯地平联合厄贝沙坦治疗糖尿病合并高血压,并分析患者血糖、血糖变化,现报告如下。1资料与方法1.1临床资料:2016年8月至2018年3月在我院选取120例糖尿病合并高血压的患者,采用随机数     

老年高血压合并糖尿病降压药物的选择

目的对高血压合并糖尿病的临床特点和常用药物的选择进行综述。方法选用关键词为“高血压”,“糖尿病”,“降压药物”的文章进行分析和总结。结果高血压和糖尿病均是老年人常见的慢性病,且两者常并存,这两种慢性疾病均是导致脑卒中、心肌梗死、心力衰竭、慢性肾脏损害的重要危险因素。临床常用的六大类抗高血压药物各有利弊,选择时应根据药物的作用特点,综合考虑药物的不良反应以及用药个体化合理选择。结论ACEI在降压的同时可增加组织对内源性和外源性胰岛素的敏感性,延缓糖尿病肾病以及减少糖尿病心血管病等并发症的发生,可作为首选用药。联合用药时可加CCB或ARB。     

联合降压最佳拍档

糖尿病合并高血压的患者,该如何运用降压药呢?临床实践证明,这类患者需要多种降压药物联合治疗.其优势在于:平稳降压,有效帮助降压达标,保护心脑肾等重要器官.     

高血压合并糖尿病患者降压药物的应用分析

目的为了给高血压合并糖尿病患者提供治疗依据,根据患者用药情况,分析探讨适宜给患者使用的降压药物。方法随机选择病例进行分组,一组为患有高血压合并糖尿病的试验组;一组为患有未合并糖尿病的对照组。根据患者的用药情况和用药疗效等方面做回顾性分析。结果血管紧张素Ⅱ受体阻断药(ARB)以及血管紧张素转换酶抑制剂(ACEI),较多应用于高血压合并糖尿病的治疗方案中,对照组的平均服用降压药物种类少于研究组。结论必须根据高血压合并糖尿病患者实际情况,分析患者的综合因素,才能给患者提供最安全有效的降压治疗方案。     

Arterial 'prehypertension': a useful concept for drug companies, useless for patients

(1) Elevated blood pressure is an independent and progressive cardiovascular risk factor. The risk starts to increase above a threshold of 115/75 mmHg. (2) The threshold values for blood pressure with practical implications for patients' health have been determined from clinical trial results. These are, for example, 160/95 mmHg in patients without diabetes and complications of hypertension, and 140/80 mmHg in patients with diabetes or a history of stroke. (3) A prospective cohort analysis confirmed the progressive nature of the relation between blood pressure and the risk of cardiovascular events: after about 12 years the incidence of cardiovascular events was 7% when blood pressure was less than 120/80 mmHg and 12% when it was between 130/85 and 140/90 mmHg. However, patients with these moderately elevated blood pressure values were also more likely to be diabetic. (4) The only trial involving patients with systolic pressure values between 130 and 139 mmHg, levels referred to by some as 'prehypertension', was not designed to determine either the clinical benefits or the adverse effects of treatment with candesartan. Two years after withdrawal of this antihypertensive drug, there was no statistically significant difference in the proportion of patients requiring antihypertensive treatment (threshold 160/100 mmHg). (5) In practice, 'prehypertension' is not a useful concept for patient management. The blood pressure thresholds above which the risk-benefit balance for some treatments becomes positive, in terms of morbidity or mortality, remain at 160/95 mmHg for patients without diabetes or complications and 140/80 mmHg for patients with diabetes or a history of stroke.     

What is the Optimal Blood Pressure in Patients with Diabetes Mellitus?

Cardiovascular disease is the number one cause of death in patients with type 2 diabetes mellitus. This condition leads to an increased risk of premature mortality in patients with ischemic heart disease and stroke. Many risk factors besides hyperglycemia in itself contribute to this increased risk, acting in a synergistic fashion. One of the most important risk factors is hypertension. Several recent clinical trials have shown the benefits of reducing high blood pressure in patients with diabetes mellitus to lower levels than have previously been recommended in clinical guidelines. In both the United Kingdom Prospective Diabetes Study (UKPDS) and the Hypertension Optimal Treatment (HOT) study a significant trend for increased benefits associated with lower diastolic blood pressure levels was shown. Therefore, clinicians should be encouraged to do more to treat hypertension in patients with type 2 diabetes mellitus and increase the proportion of patients in whom acceptable blood pressure control is achieved. For example, in Sweden, acceptable blood pressure control is currently only achieved in about 20 to 25% of patients with type 2 diabetes mellitus. Recent evidence also points to the primary importance of a tight blood pressure control. This implies drug combination treatment for the majority of patients. Therefore, the clinician must be able to use a broad variety of antihypertensive drugs, and from these drugs choose alternative combinations with pharmacological synergism.     

高血压前期肥胖患者非药物治疗效果的观察

目的:观察高血压前期肥胖患者生活方式改变对其血压的影响。方法:随访2011年3月—2013年2月就诊的高血压前期、肥胖、有明显心血管病风险,使用单一药物即可控制血压的患者。使用方差分析和t检验评估生活方式改变对血压的影响趋势。结果:经随访分析连续入选的421名高血压前期患者,发现两组的血压变化趋势无显著性差异。生活方式改变+安慰剂组73%的患者体重减轻,与单一抗高血压药物组比较差异有统计学意义(P<0.05)。并且该组患者平均24 h尿钠排泄量减低,与单一抗高血压药物组比较差异有统计学意义(P<0.001)。尽管与单一药物抗高血压组比较,无论是收缩压或舒张压的变化,生活方式改变+安慰剂组都处于略高水平,但同时发生在单一药物抗高血压组与抗高血压药物服用相关的不良反应高达16.7%。结论:对高血压前期的肥胖患者,采用针对性的非药物治疗方式联合应用,可能有显著控制血压的作用。     

Assessment of factors influencing blood pressure control in a managed care population

We attempted to determine the percentage of patients meeting Health Plan Employer Data Information Set (HEDIS) criteria for blood pressure control (< or = 140/90 mm Hg), to identify factors contributing to differences in blood pressure control among those who met HEDIS criteria and those who did not, and to assess compliance with blood pressure management recommendations established by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) for diabetes mellitus and myocardial infarction. In this retrospective analysis, we randomly selected 502 patient records from three primary care clinics in southeast Michigan. All patients were commercial members of one health maintenance organization, 74% of whom met HEDIS criteria for blood pressure control. These patients took fewer blood pressure drugs throughout the year (p=0.023) and had lower antihypertensive drug costs than those who did not achieve HEDIS blood pressure goals (p=0.016). According to JNC-VI criteria, 46% of diabetic patients were at their blood pressure goal of below 130/85 mm Hg and 71.6% were managed with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Eighty-five percent of patients were taking beta-blockers after myocardial infarction. The percentage of patients achieving target blood pressure exceeded the national average and was associated with few antihypertensive drugs and low drug cost. Effective and appropriate management of blood pressure in people with diabetes remains a challenge.     

Blood pressure lowering for the prevention and treatment of diabetic kidney disease

The current pandemic of diabetes mellitus will inevitably be followed by an epidemic of chronic kidney disease. It is anticipated that 25-40% of patients with type 1 diabetes and 5-40% of patients with type 2 diabetes will ultimately develop diabetic kidney disease. The control of blood pressure represents a key component for the prevention and management of diabetic nephropathy. There is a strong epidemiological connection between hypertension in diabetes and adverse outcomes in diabetes. Hypertension is closely linked to insulin resistance as part of the 'metabolic syndrome'. Diabetic nephropathy may lead to hypertension through direct actions on renal sodium handling, vascular compliance and vasomotor function. Recent clinical trials also support the utility of blood pressure reduction in the prevention of diabetic kidney disease. In patients with normoalbuminuria, transition to microalbuminuria can be prevented by blood pressure reduction. This action appears to be significant regardless of whether patients have elevated blood pressure or not. The efficacy of ACE inhibition appears to be greater than that achieved by other agents with a similar degree of blood pressure reduction; although large observational studies suggest the risk of microalbuminuria may be reduced by blood pressure reduction, regardless of modality. In patients with established microalbuminuria, ACE inhibitors and angiotensin receptor antagonists (angiotensin receptor blockers [ARBs]) consistently reduce the risk of progression from microalbuminuria to macroalbuminuria, over and above their antihypertensive actions. The clinical utility of combining these strategies remains to be established. In patients with overt nephropathy, blood pressure reduction is associated with reduced urinary albumin excretion and, subsequently, a reduced risk of renal impairment or end stage renal disease. In addition to actions on systemic blood pressure, it is now clear that ACE inhibitors and ARBs also reduce proteinuria in patients with diabetes. This anti-proteinuric activity is distinct from other antihypertensive agents and diuretics. Although there is a clear physiological rationale for blockade of the renin angiotensin system, which is strongly supported by clinical studies, to achieve the optimal lowering of blood pressure, particularly in the setting of established diabetic renal disease, a number of different antihypertensive agents will always be needed. In the end, the choice of agents should be individualised to achieve the maximal tolerated reduction in blood pressure and albuminuria. Ultimately, no matter how it is achieved, so long as it is achieved, renal risk can be reduced by agents that lower blood pressure and albuminuria.     

Current treatment of patients with hypertension: therapeutic implications of INSIGHT

When planning treatment for patients with hypertension, current guidelines emphasise the importance of risk stratification, based on blood pressure, the presence of end-organ damage and other cardiovascular risk factors. Because the beneficial effect of antihypertensive therapy seems to be linked to the degree of blood pressure reduction, guidelines recommend reducing blood pressure below 140/90mm Hg, with a lower target in patients who are young or who have diabetes mellitus (with or without nephropathy) or non-diabetic nephropathy. Blood pressure reduction can be achieved with several classes of drugs, including diuretics, beta-blockers, ACE inhibitors, angiotensin II antagonists and calcium channel antagonists. Calcium channel antagonists have been shown to reduce the risk of stroke and major cardiovascular events. However, it is still controversial whether different treatment regimens based on different drug classes can offer advantages beyond similar degrees of blood pressure control in preventing cardiovascular morbidity and mortality. The International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT) was a controlled clinical trial aimed at comparing the efficacy of a long-acting calcium channel antagonist, nifedipine gastrointestinal-transport-system (GITS), versus co-amilozide, a combination of the diuretics hydrochlorothiazide (HCTZ) and amiloride, on morbidity and mortality in high-risk hypertensive patients. Nifedipine GITS and HCTZ/amiloride were equally effective at reducing blood pressure and the risk of primary outcomes (a composite of death from any cardiovascular or cerebrovascular cause, non-fatal stroke, myocardial infarction and heart failure). Results from other studies indicate that there may be greater benefits for stroke and smaller benefits for coronary artery disease with calcium channel antagonist-based regimens than with diuretic or beta-blocker-based regimens. However, there is at present insufficient evidence to recommend a specific drug choice based on patient risk profile. Thus, the choice of antihypertensive drug(s) should be according to efficacy and tolerability. In addition to the reductions in cardiovascular risk, two substudies of INSIGHT showed that nifedipine GITS was able to prevent the progression of intima media thickness in the common carotid artery and slow the progression of coronary calcification. The clinical significance of this effect in the prevention of cardiovascular events still remains to be established.     

A practical guide to the management of hypertension in renal transplant recipients

Hypertension as well as hypotension can be harmful to a newly transplanted renal allograft. Elevated blood pressure is also a major risk factor for cardiovascular death, which is a frequent occurrence despite successful renal transplantation. Renal artery stenosis, immunosuppressive drugs, chronic rejection, retained native kidneys, and excessive extracellular fluid volume may all contribute to post-transplant hypertension. Antihypertensive agents are widely used in the management of post-transplant hypertension. Careful clinical judgement and knowledge of the pharmacology, pharmacodynamics, pharmacokinetics, adverse drug reaction profiles, potential contraindications, and drug-drug interactions of antihypertensive agents are important when therapy with antihypertensive drugs is initiated in renal transplant recipients. Since blood pressure elevation in any individual is determined by a large number of hormonal and neuronal systems, the effect of antihypertensive agents on the allograft should be considered a critical factor in the management of hypertension in renal transplant recipients. Most renal transplant recipients have other risk factors for premature cardiovascular death such as diabetes mellitus, hypercholesterolemia, insulin resistance, obesity, left ventricular hypertrophy and ischaemic heart disease. Initial antihypertensive therapy should be tailored individually according to the patient's risk factors. A realistic therapeutic goal for blood pressure management in the initial post-operative state is a systolic blood pressure <160 mm Hg and a diastolic blood pressure <90 mm Hg with lower pressure targets becoming applicable late post-transplantation.     

Improved outcomes with antihypertensive medication in the elderly with isolated systolic hypertension

Isolated systolic hypertension affects over 15% of all individuals aged >60 years. In the elderly, systolic hypertension is a major modifiable cardiovascular risk factor. Systolic blood pressure (SBP) is associated with higher risk of an adverse outcome, whereas diastolic blood pressure (DBP) is inversely correlated with total mortality, independent of SBP, highlighting the role of pulse pressure as a risk factor. Three placebo-controlled outcome trials on antihypertensive drug treatment in older patients with isolated systolic hypertension have been published: the Systolic Hypertension in the Elderly Program (SHEP), the Systolic Hypertension in Europe (Syst-Eur) Trial and the Systolic Hypertension in China (Syst-China) Trial. These 3 trials demonstrated the benefit of antihypertensive drug treatment. A meta-analysis was performed by pooling the patients from these 3 trials with a subset of patients with isolated systolic hypertension from 5 other trials in the elderly. The pooled results of 15,693 older patients with isolated systolic hypertension prove that antihypertensive drug treatment isjustified if on repeated clinic measurements SBP is 160 mm Hg or higher.     

两种降压联合用药方案对高血压合并糖尿病患者血压变异性影响的比较

目的比较两种降压联合用药方案对高血压合并糖尿病患者血压变异性影响。方法 68例高血压合并2型糖尿病患者分为2组,分别使用缬沙坦胶囊联合吲达帕胺片及依那普利胶囊联合硝苯地平缓释片降压治疗,治疗前及治疗3个月后分别进行24h动态血压监测,观察血压控制情况,比较两组降压联合用药方案治疗前后血压变异性指标。结果使用两种降压联合用药方案均显著降低血压,均可降低血压变异性,但服用缬沙坦胶囊联合吲达帕胺片治疗的患者血压变异性指标优于服用依那普利胶囊联合硝苯地平缓释片的患者。结论两种降压联合用药方案对高血压合并2型糖尿病患者均能有效降压,但考虑降低血压变异性,缬沙坦胶囊联合吲达帕胺片优于依那普利胶囊联合硝苯地平缓释片。