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在2型糖尿病中降低血压:系统性审查和元分析
Connor A Emdin1, Kazem Rahimi1, Bruce Neal2
1The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.
JAMA
|February 11, 2015
概括
降低2型糖尿病患者的血压可以显著降低死亡率和血管事件. 益处在较高的基线血压下更为明显,支持药物使用.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 临床研究 临床研究
背景情况:
- 血压管理对于降低糖尿病患者血管风险至关重要.
- 2型糖尿病与心血管疾病发病率和死亡率的增加有关.
研究的目的:
- 研究2型糖尿病患者的降血压治疗与血管结果之间的关联.
- 评估基线和达到的血压水平对治疗疗效的影响.
主要方法:
- 进行了对糖尿病患者降血压治疗的大规模随机对照试验 (RCT) 的系统搜索.
- 从40个偏差风险较低的试验 (100,354名参与者) 的数据中提取并使用固定效应元分析进行分析.
- 结果包括全因死亡率,心血管事件,中风,心力衰竭,视网膜病变,白蛋白尿和衰竭.
主要成果:
- 每降低10mmHg的缩血压都与显著降低死亡率,心血管事件,冠心病,中风,白色素尿和视网膜病变的风险有关.
- 在多种血管结局中观察到绝对风险降低.
- 较低的相对风险在高平均基线缩血压 (≥140 mm Hg) 的试验中被注意到.
结论:
- 降低血压与2型糖尿病患者的死亡率和临床结果的改善有关.
- 降低血压的好处在具有较高基线血压的个体中更为明显.
- 这些发现强化了抗高血压药物在2型糖尿病管理中的重要性.
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