糖尿病或糖耐量受损人群血压达到140/90 mm Hg时继续降压是否有益的Meta分析

 目的 评价糖尿病人群血压≤140/90 mm Hg（1 mm Hg=0.133 kPa）时继续降压是否有益。方法 检索 MEDLINE、EMBASE、IPA数据库及二次资源。检索词为血压、高血压、降压药物。入选试验条件：随机对照试验，试验对象为糖尿病或糖耐量受损的人群，试验终点人群平均血压≤140/90 mm Hg，强化降压组与常规治疗组间终点血压差异有统计学意义。共检索到16篇文献满足试验条件，总计51 470例病人。采用RR和95%CI作为评价强化降压组和常规治疗组各种临床结局有无差异的指标。统计学分析应用RevMan5.0软件。结果 对于糖尿病人群，当血压≤140/90 mm Hg时，继续降压可减少心血管事件发生率(RR 0.91；95%CI 0.87～0.96，P=0.0004)和卒中的发生率(RR 0.75； 95%CI 0.63～0.88，P=0.0005)，但增加了症状性低血压 (RR 3.57；95%CI 1.41 ～11.20， P=0.03)及高钾血症的发生率(RR 1.57； 95%CI 1.05～2.33， P=0.03)。强化降压和常规治疗组间全因死亡率（RR 0.94，95%CI 0.87~1.01，P=0.08）、心血管病死亡率(RR 0.95； 95%CI 0.85～1.08， P=0.05)、心肌梗死发生率(RR 0.93； 95%CI 0.82～1.05，P=0.26)、心力衰竭入院率(RR 0.90；95%CI 0.76～1.06，P=0.21)差异无统计学意义。结论 对于糖尿病人群，当血压降到140/90 mm Hg以下时，继续降压获益减少，同时风险增加。

The efficacy of antihypertensive treatment on diabetes mellitus or impaired glucose tolerance patients with blood pressure below 140/90 mm Hg: a meta-analysis

Objective To investigate whether antihypertensive treatment is beneficial to patients with diabetes mellitus when their blood pressure (BP) is below 140/90 mm Hg（1 mm Hg=0.133 kPa）.Methods MEDLINE, EMBASE, IPA database and secondary resources were searched with terms including blood pressure, hypertension and anti-hypertension drug. Inclusion criteria: random control study; subjects were patients with diabetes mellitus or impaired glucose tolerance; endpoint BP ≤140/90 mm Hg; endpoint BP between two groups had significant differences. There were 16 studies meet inclusive criteria with a total of 51 470 patients. RR and 95%CI were used as index to judge the difference of clinical outcomes between aggressive antihypertensive treatment group and standard antihypertensive treatment group. RevMan5.0 software was used for statistical analysis. Results When BP of patients with diabetes mellitus were below 140/90 mm Hg, anti-hypertensive treatment could reduce incidence rate of cardiovascular event (RR 0.91, 95%CI 0.87-0.96, P=0.0004) and stroke (RR 0.75, 95%CI 0.63-0.88, P=0.0005), and increased incidence rate of symptomatic hypotension (RR 3.57, 95%CI 1.41-11.20, P=0.03) and hyperpotassemia (RR 1.57, 95%CI 1.05-2.33, P=0.03). There were no significant differences in all-cause mortality (RR 0.94, 95%CI 0.87-1.01, P=0.08), cardiovascular mortality (RR 0.95, 95%CI 0.85-1.08, P=0.05), myocardial infarction (RR 0.93, 95%CI 0.82-1.05, P=0.26), heart failure (RR 0.90, 95%CI 0.76-1.06, P=0.21) between the aggressive antihypertensive treatment group and standard antihypertensive treatment group. Conclusions When blood pressure of patients with diabetes mellitus was below 140 mm Hg, there was little benefit from aggressive antihypertensive treatment, and the risk of serious adverse events even increased.