高血压并糖尿病患者需要更严格地控制血压

1、1.01.62.12.53.24.14.87.911.8024681012 sbp 110 110- 120- 130- 140- 150- 160- 170- 180- dbp 75 75- 80- 85- 90- 95- 100- 105- 110- 人数比例(%) 21 20 21 11 13 5 4 2 3 rr108/90396/105955/100510.3%7.8%4.9%bp130-139 85-89120-129 80-84 120 80vascular events(%) 非高血压者的心血管事件非高血压者的心血管事件yeas fig 7. cumulative incide

2、nce of vascular events for 10 years in 2967 men from framingham heart study 0 02 24 46 68 8101012121414120120130130140140150150160160170170脑卒中率/1000人 年糖尿病平均收缩压糖尿病平均收缩压(mmhg)与脑卒中发生率与脑卒中发生率(%)ukpds: 4801例例糖尿病糖尿病 (50-54岁岁) 随访随访10年年sbp14.420.322.223.829.136.20510152025303540 120 130 140 150 160 170mmhg总

3、死亡(%)ukpds: 糖尿病m sbp水平与死亡率关系水平与死亡率关系 （随访（随访10年）年）effects of a fixed combination of the ace inhibitor, perindopril, and the diuretic, indapamide on major vascular events 2.2 mmhg (95% ci 2.0-2.4); p0.001 5.6 mmhg (95% ci 5.2-6.0); p0.12.0number of eventsper-indplacebo(n=5,569)(n=5,571)relative riskre

4、duction (95% ci)favoursper-indfavoursplacebohazard ratio0.51.0age (years)= 6553659211% (0 to 21)sexmale546594 10% (-1 to 20)female315344 8% (-7 to 21)sbp (mmhg) 7.545148111% (-1 to 22)all participants861938 9% (0 to 17) *2p=0.02non-fatal mi or death from coronary heart diseaseunstable angina requiri

5、ng hospitalisation, coronary revascularisation or silent mimajor coronary heart disease265294 11% (-6 to 24)all coronary heart disease468535 14% (2 to 24)other coronary heart disease283324 14% (-1 to 27)*number of eventsper-indplacebo(n=5,569)(n=5,571)relative riskreduction (95% ci)favoursper-indfav

6、oursplacebohazard ratio0.51.02.0major cerebrovascular disease215218 2% (-18 to 19)all cerebrovascular disease286303 6% (-10 to 20)other cerebrovascular disease7999 21% (-6 to 41)2.0* *2p=0.40non-fatal stroke or death from cerebrovascular diseasetransient ischaemic attack or subarachnoid haemorrhagen

7、umber of eventsper-indplacebo(n=5,569) (n=5,571)relative riskreduction (95% ci)favoursper-indfavoursplacebohazard ratio0.51.02.0hazard ratio0.51.0new or worsening nephropathy181216 18% (-1 to 32)new microalbuminuria10941317 21% (14 to 27)total renal events12431500 21% (15 to 27)* *2p=0.01number of e

8、ventsper-indplacebo(n=5,569) (n=5,571)relative riskreduction (95% ci)favoursper-indfavoursplacebo2.0hazard ratio0.51.0 *2p=0.09new or worsening eye disease289286 -1% (-18 to 15)visual deterioration24462514 5% (-1 to 10)total eye events25312611 5% (-1 to 10)*number of eventsper-indplacebo(n=5,569)(n=

9、5,571)relative riskreduction (95% ci)favoursper-indfavoursplacebobenefits appeared to be similar in all major subgroups. treatment was very well tolerated, with few side effects and adherence similar to that with placebo.*mostly new onset microalbuminuria0.10.52.010 脑卒中:abcdhot ukpds严格降压 常规降压relativ

10、e risk ( 95% ci )0.98 (0.402.43)0.80 (0.411.56)0.56 (0.370.90) 严格降压与常规降压对糖尿病患者脑卒中事件的影响严格降压与常规降压对糖尿病患者脑卒中事件的影响 0.10.52.010 心血管总事件：abcdhot ukpds严格降压 常规降压relative risk ( 95% ci )0.91 (0.601.37)0.67 (0.451.00)0.69 (0.550.86)严格降压与常规降压对糖尿病患者心血管事件的影响严格降压与常规降压对糖尿病患者心血管事件的影响 卒中卒中 dm 终点终点dm死亡死亡微血管病微血管病ukpds: 严格降糖严格降糖与与严格降压严格降压治疗终点减少治疗终点减少(%)的比较的比较