抗高血压药物引起的糖尿病不容忽视（英文）

DRUGINDUCEDDIABETESDURINGANTIHYPERTENSIVETHERAPYISIMPORTANT BUT CHINESESOCIETYOFHYPERTENSIONMICHAELALDERMANMAY22 2008 PrevalenceofdiabetesamongChineseadultsaged35 64yearsinthe1994ChineseNationalSurvey 10 and2000 2001InterASIAStudy GuetalDiabetologia 2003 46 1190 Percentofdeaths GeissLS etal In DiabetesinAmerica NationalInstitutesofHealth 1995 65 ofMortalityinpeoplewithDiabetesisCVD Ischemicheartdisease Otherheartdisease Diabetes Malignantneoplasms Cerebrovasculardisease Pneumonia influenza Allother CVmortalityrateper10 000person years SystolicBPandCVDeathinMRFIT Nondiabetic n 342 815 Diabetic n 5 163 120 120 139 SystolicBP mmHg 140 159 160 179 180 199 200 StamlerJ etal DiabetesCare 1993 16 434 444 BP bloodpressureCV cardiovascularMRFIT MultipleRiskFactorInterventionTrial AnnualIncidenceofDiabetesinHypertensivePatients SHEPuntreatedcontrols 2 7 SHEPtreated 3 9 Lancet 2006 368 1673 1679 AmJCardiol 2005 95 29 Hypertension 2007 50 467 JAMA2002 288 2981 2997 NHANES18yearFollow upNODinUSWomenbyBaselineBP Conen D etal EurHeartJ200728 2937 2943 120 120 129 130 139 140 mmHg Conen D etal EurHeartJ200728 2937 2943 Age adjustedincidencerates A andHRs B ofNODaccordingtobloodpressurecategory stratifiedbybaselinebodymassindex THEISSUES CONSEQUENCESOFNODCVDANDnon CVDHOWDOANTIHYPERTENSIVEDRUGSEFFECTINCIDENCEOFNODANDCVDONSEQUENCES HOWSHOULDNODEFFECTMANAGEMENTFORCVDPROTECTION Non CVDConsequencesofNOD ImpairedBPcontrolBehavioralandPsychologicalMicrovascularconsequences MedicalcaredemandsTreatmentchanges CVDConsequences ShortandLongtermAntihypertensiveDrugRelated Whelton P K etal ArchInternMed2005 165 1401 1409 ALLHATIncidenceofCoronaryheartdiseasebytreatmentgroupaccordingtobaselinediabetesmellitus impairedfastingglucoselevel ornormoglycemia Barzilay J I etalALLHAT ArchInternMed2006 166 2191 2201 HR sofa10 mg dL 0 56 mm FBGat2yearsforsubsequentCVDandRenalDisease EffectofACEIsandARBsonCVDMortality Gillespie etal DiabetesCare28 2261 2266 2005 Age gender adjustedintreatmentCVDandnon CVDbybaselineFBGamonghypertensivepatients Alderman Hypertension 1999 33 1130 1134 Myocardialinfarction fatalandnonfatal inhypertensivepatientsaccordingtoDMstatus Aksnes T A etal Hypertension2007 50 DiabetesIncidence 4Years follow upFBS 126mg dLforthose 126mg dLatbaseline p 05comparedtochlorthalidone JAMA2002 288 2981 2997 Ramiprilv PlaceboinhighriskpatientswithIGTatbaseline Dream NEJM 355 1551 1562 2006 Ramiprilv PlaceboCVD non CVDOutcomes Dream NEJM 355 1551 1562 2006 Whelton P K etal ArchInternMed2005 165 1401 1409 ALLHAT RR and6 yearratesper100fornondiureticcomparedwithdiureticfordiabetesmellitus A impairedfasingglucoselevel B andnormoglycemia C atbaseline forCHD all causemortality combinedCHD stroke HF allCVD andESRD CVdeath PLACEBO ACTIVE p 0 05vsnodiabetes SHEP 14YEARFOLLOW UP CONCLUSIONSFROMSHEP ChlorthalidoneRxofhypertensionimproveslong termoutcomes Thediabetesrelatedtochlorthalidonetherapyhasbetterprognosisthandiabetesatbaseline Thebenefitofchlorthalidone basedtherapyonlong termtotalandCVmortalityismostpronouncedinhypertensivepatientswithdiabetes ReductioninmajorCVDamong6 000DMinHPSassociatedwith38 89 LDL CHOLbyStatin Mazzone T TheAmericanJournalofMedicine120 2007 S26 S32 IncidenceofMIandMicrovascularEndpointsbyMeanSBPandHbA1cinUKPDS Adjustedincidenceper1000person years UpdatedmeanHbA1cconcentration MeanSBP mmHg Adjustedincidenceper1000person years 5 6 7 8 9 10 11 110 120 130 140 150 160 170 Myocardialinfarction Microvascularendpoints Microvascularendpoints Myocardialinfarction AdlerAI etal BMJ 2000 321 412 419 StrattonIM etal BMJ 2000 321 405 412 MI myocardialinfarctionSBP systolicbloodpressure UNCERTAINTYCONTINUESACCORDANDADVANCE ACCORD MortalitygreaterwithHbAlc 6 4v 7 0 7 9 ADVANCE Noevidenceof mortalitywithHbAlc6 4v 7 5 MajorCVEventRateInHOT HOT Lancet1998 351 1755 p 0 00551 riskreduction GoalDiastolicmmHg Diabeticpopulation Non Diabeticsubjects CONCLUSIONS DMseriouswheneveritoccursMorecommoninhypertensiveRxParticularlywithdiureticsNODhasconsequencesNon CVDinshorttermCVDlongtermNeitherfearof norNOD requiresD CD