高血压病伴糖尿病的处理教程.pptVIP

* 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 2008 12 13 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% HbA1c: 6.5% Initial FU: 7.8y Extended FU: 13.3y NEJM 2003; 348:383 NEJM 2008; 358:580 高血压的发病率 IN DIABETES % with BP ? 140/90 All U.S. adults 30% Diabetic U.S. adults 60% ? Type 1 DM - Normoalbuminuria 30% - Microalbuminuria 40% - Macroalbuminuria 80% ? Type 2 DM - At Dx 50% - Microalbuminuria 80% - Macroalbuminuria 95% NEJM 2000; 342:905 Diabetes Care 2005; 28:310 Am J Kid Dis 2007; 49 (Suppl 2):S74 J Cardiometab Syndr 2006; 1:95 (86% ≥ 130/80) 高血压增加糖尿病病人的并发症 Relative Risk of Complications Diabetes vs No Diabetes: CVD 2.0 – 4.0 ESRD 7.0 Diabetes ? ? BP vs Diabetes CHD 3.0 Stroke 4.0 Retinopathy 2.0 Nephropathy 2.0 Neuropathy 1.6 Mortality 2.0 75% die from CVD JAMA 2004; 292:2495 Kid Internat 2000; 59:703 NEJM 2005; 352:341 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 Diabetes Care 1994; 17:1247 Lancet 2002; 360:1903 Hypertension 2003; 42:1206 糖尿病伴高血压病的控制达标现状 % With BP 130/80 NHANES, 2003-2004 35% VA, 2001-2002 23% Community 1? care, 2002-2004 31-35% Academic medicine, 2002 33% GEMINI RCT, 2004 68% Arch Int Med 2007; 167:2394 JAMA 2004; 292:2227 Ann Fam Med 2006; 4:23 J Gen Intern Med 2006; 21:1050 控制不理想的原因何在？ 疾病本身的原因 Most DM pts need 3-4 drugs to control BP Activation of RAA – system Volume overload, especially if CKD Sleep apnea from associated obesity Vascular damage J Hypertens 2005; 23:2305 Hypertension 2000; 35:1038 Am J Hypertens 2004; 17:915 J Cardiometab Syn 2007; 2:114 控制不理想的原因何在？ 用药依从性低