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2型糖尿病患者和没有2型糖尿病患者的强化血压控制与标准血压控制:系统性审查和元分析
João Victor de Oliveira Ramos1, João Vitor Andrade Fernandes1, Flávia Maria Camilo Madruga de Oliveira Lima1
1Medical Sciences Center, Federal University of Paraíba, João Pessoa, Brazil.
概括
通过减少心血管事件,密集的血压控制有利于非糖尿病患者. 对于2型糖尿病患者来说,益处不太清楚,可能涉及安全问题,需要个性化的目标.
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:
- 对于患有或没有2型糖尿病 (T2D) 的患者来说,最佳的血压 (BP) 控制强度尚不清楚.
- 需要进行系统审查,以澄清针对不同患者群体的血压控制指南.
研究的目的:
- 系统地审查和元分析随机对照试验,比较密集与标准血压控制.
- 根据T2D状态对分析进行分层,以确定差异效应.
主要方法:
- 六项随机对照试验的元分析,涉及41210名参与者.
- 主要结局包括全因死亡率和严重不良事件 (SAE).
- 二次结局评估了心血管死亡,心肌梗塞 (MI) 和中风,使用随机效应模型和异质性评估.
主要成果:
- 密集的血压控制显著减少了心血管死亡 (OR 0.72),心肌梗塞 (OR 0.85) 和中风 (OR 0.78).
- 在非T2D患者中,全因死亡率的降低是显著的 (OR 0.73),但在T2D患者中没有 (OR 0.99).
- 在密集控制下观察到非显著的SAE增加 (OR 1.15),特别是在T2D患者中.
结论:
- 密集的血压控制有效地减少了没有T2D的患者心血管事件和死亡率.
- 在T2D患者中,密集血压控制的好处减少,并可能被安全问题所抵消.
- 根据糖尿病状况和临床因素推个性化BP目标.
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