抗高血压药物引起的糖尿病不容忽视ppt课件

1、DRUG INDUCED DIABETES DURING ANTIHYPERTENSIVE THERAPY IS IMPORTANT - BUTCHINESE SOCIETY OF HYPERTENSIONMICHAEL ALDERMANMAY 22, 2021Prevalence of diabetes among Chinese adults aged 3564 years in the 1994 Chinese National Survey (10) and 20002001 InterASIA StudyNoImageGu et al Diabetologia. 2003;46:11

2、90.Percent of deathsGeiss LS, et al. In: Diabetes in America. National Institutes of Health;1995.65% of Mortality in people with Diabetes is CVD Ischemic heart diseaseOther heart diseaseDiabetesMalignant neoplasmsCerebrovascular diseasePneumonia/influenzaAll otherCV mortality rate per10,000 person-y

3、earsSystolic BP and CV Death in MRFITNondiabetic (n=342,815)Diabetic (n=5,163)120120-Systolic BP (mmHg)140-159160-179180-199 200Stamler J, et al. Diabetes Care. 1993;16:434-444.BP= blood pressure CV=cardiovascular MRFIT=Multiple Risk Factor Intervention TrialAnnual Incidence of Diabetes in Hypertens

4、ive PatientsSHEP untreated controls = 2.7%SHEP treated = 3.9%Lancet. 2006, 368;1673-1679, Am J Cardiol. 2005;95:29,Hypertension.2007;50:467, JAMA 2002;288:2981-2997 NHANES 18 year Follow-upNOD in US Women by Baseline BPNoImageConen, D. et al. Eur Heart J 2007 28:2937-2943140mmHg.Conen, D. et al. Eur

5、 Heart J 2007 28:2937-2943Age-adjusted incidence rates (A) and HRs (B) of NOD according to blood pressure category, stratified by baseline body mass indexTHE ISSUESCONSEQUENCES OF NODCVD AND non-CVDHOW DO ANTIHYPERTENSIVE DRUGS EFFECT INCIDENCE OF NOD AND CVD ONSEQUENCES?HOW SHOULD NOD EFFECT MANAGE

6、MENT FOR CVD PROTECTION?Non-CVD Consequences of NOD Impaired BP control Behavioral and Psychological Microvascular consequences (?) Medical care demands Treatment changesCVD Consequences Short and Long term Antihypertensive Drug Related.Whelton, P. K. et al. Arch Intern Med 2005;165:1401-1409.ALLHAT

7、Incidence of Coronary heart disease by treatment group according to baseline diabetes mellitus, impaired fasting glucose level, or normoglycemiaBarzilay, J. I. et al ALLHAT. Arch Intern Med 2006;166:2191-2201.HRs of a 10-mg/dL (0.56-mm) FBG at 2 years for subsequent CVD and Renal Disease Effect of A

8、CEIs and ARBs on CVD MortalitySource # studies #subjectsOR (95% CI)All11109,0520.96(0.91-1.01)ACEI674,6260.93(0.81-1.06)ARB534,4260.93 (0.81-1.06)HTN786,4140.99 (0.93-1.06)Gillespie, et al. Diabetes Care 28:2261-2266, 2005Age-genderadjusted in treatment CVD and non-CVD by baseline FBG among hyperten

9、sive patients.Alderman, Hypertension. 1999;33:1130-1134Myocardial infarction (fatal and nonfatal) Myocardial infarction (fatal and nonfatal) in hypertensive patients according to DM in hypertensive patients according to DM statusstatusAksnes, T. A. et al. Hypertension 2007;50Aksnes, T. A. et al. Hyp

10、ertension 2007;50Diabetes Incidence - 4 Years(follow-up FBS 126 mg/dL for those 126 mg/dL at baseline)NoImageJAMA 2002;288:2981-2997Ramipril v. Placebo in high risk patients with IGT at baselineDream. NEJM;355:1551-1562,2006NoImageRamipril v. Placebo CVD & non-CVD OutcomesDream. NEJM;355:1551-15

11、62,2006NoImage.Whelton, P. K. et al. Arch Intern Med 2005;165:1401-1409.ALLHAT: RR (and 6-year rates per 100 for nondiuretic compared with diuretic for diabetes mellitus (A), impaired fasing glucose level (B), and normoglycemia (C) at baseline, for CHD, all-cause mortality, combined CHD, stroke, HF,

12、 all CVD, and ESRDNoImagePLACEBOACTIVE* = p 0.05 vs no diabetesSHEP - 14 YEAR FOLLOW-UPCONCLUSIONS FROM SHEP + Chlorthalidone Rx of hypertension improves long-term outcomes. The diabetes related to chlorthalidone therapy has better prognosis than diabetes at baseline. The benefit of chlorthalidone-b

13、ased therapy on long-term total and CV mortality is most pronounced in hypertensive patients with diabetes. Reduction in major CVD among 6,000 DM in HPS associated with 38/89 LDL/CHOL by StatinNoImageMazzone, T.The American Journal of Medicine 120;2007, S26-S32 NoImageIncidence of MI and Microvascul

14、ar Endpoints by Mean SBP and HbA1c in UKPDSAdjusted incidence per 1000 person-years (%)Updated mean HbA1c concentration (%)Mean SBP (mmHg)NoImageNoImageAdjusted incidence per 1000 person-years (%)5678910 11110120130140150160170Myocardial infarctionMicrovascular endpointsMicrovascular endpointsMyocar

15、dial infarctionAdler AI, et al. BMJ. 2000;321:412-419.Stratton IM, et al. BMJ. 2000;321:405-412.MI=myocardial infarction SBP=systolic blood pressureUNCERTAINTY CONTINUESACCORD AND ADVANCE ACCORD - Mortality greater with HbAlc 6.4 v. 7.0-7.9% ADVANCE - No evidence of mortality with HbAlc 6.4 v. 7,5%M

16、ajor CV Event Rate In HOTHOTLancet 1998;351:1755NoImage 90 85 80 90 85 80 85.283.281.1 DBP achievedp = 0.00551% riskreductionGoal Diastolic mmHgDiabetic populationNon-Diabetic subjectsCONCLUSIONS DM serious whenever it occurs More common in hypertensive Rx Particularly with diuretics NOD has consequences Non-CVD in short term CVD long term Neither fear of, nor NOD, requi