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2型糖尿病患者的密集血压控制
Yufang Bi1,2, Mian Li1,2, Yan Liu3
1Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
The New England journal of medicine
|November 18, 2024
概括
与标准治疗 (小于140 mm Hg) 相比,强化静脉血压控制 (小于120 mm Hg) 显著减少了2型糖尿病患者的主要心血管事件. 这种方法提供了一个更安全,更有效的策略来管理高血压在这个高风险人群.
科学领域:
- 心脏病学 心脏病学
- 内分泌学 在内分泌学.
- 临床试验 临床试验
背景情况:
- 对于2型糖尿病患者来说,最佳缩血压 (SBP) 的目标仍然不确定.
- 2型糖尿病与心血管疾病 (CVD) 的风险增加有关.
研究的目的:
- 为了比较密集的SBP控制 (<120 mm Hg) 与标准的SBP控制 (<140 mm Hg) 在降低2型糖尿病患者主要心血管事件的有效性.
- 在这个患者群体中评估SBP密集控制的安全性.
主要方法:
- 一项随机对照试验,涉及12821名50岁或以上的2型糖尿病患者,在中国145个地区增加SBP.
- 患者被分配到强化治疗 (目标SBP <120 mm Hg) 或标准治疗 (目标SBP <140 mm Hg) 中,长达5年.
- 主要结局是非致命性中风,非致命性心肌梗塞,心力衰竭或心血管死亡的组合.
主要成果:
- 强化治疗组在1年内达到121.6mm Hg的平均SBP,而标准治疗组的SBP为133.2mm Hg.
- 在平均4.2年的随访期间,密集治疗组的重大心血管事件发生率明显较低 (HR,0.79;P<0.001).
- 在密集治疗组中,症状性低血压和高血压更频繁,尽管严重的不良事件类似.
结论:
- 针对120mmHg以下的SBP密集控制显著减少了2型糖尿病患者的主要心血管事件.
- 这种密集的策略似乎是安全和有效的管理心血管风险在这个人群.
- 这些发现支持在2型糖尿病和高心血管风险患者中采取更积极的血压管理方法.
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