抗高血壓藥物引起的糖尿病不容忽視英文課件

DRUGINDUCEDDIABETESDURINGANTIHYPERTENSIVETHERAPYISIMPORTANT

-BUT

CHINESESOCIETYOFHYPERTENSIONMICHAELALDERMANMAY22,2021PrevalenceofdiabetesamongChineseadultsaged35–64yearsinthe1994ChineseNationalSurvey(10)and2000–2001InterASIAStudyGuetalDiabetologia.2003;46:1190.PercentofdeathsGeissLS,etal.In:DiabetesinAmerica.NationalInstitutesofHealth;1995.65%ofMortalityinpeoplewithDiabetesisCVDIschemicheartdiseaseOtherheartdiseaseDiabetesMalignantneoplasmsCerebrovasculardiseasePneumonia/influenzaAllotherCVmortalityrateper

10,000person-yearsSystolicBPandCVDeathinMRFITNondiabetic(n=342,815)Diabetic(n=5,163)<120120-139SystolicBP(mmHg)140-159160-179180-199200StamlerJ,etal.DiabetesCare.1993;16:434-444.BP=bloodpressureCV=cardiovascularMRFIT=MultipleRiskFactorInterventionTrialAnnualIncidenceofDiabetesinHypertensivePatientsSHEPuntreatedcontrols=2.7%SHEPtreated=3.9%Lancet.2006,368;1673-1679,AmJCardiol.2005;95:29,Hypertension.2007;50:467,JAMA2002;288:2981-2997

NHANES18yearFollow-up

NODinUSWomenbyBaselineBPConen,D.etal.EurHeartJ200728:2937-2943<120120-129130-139>140mmHg.Conen,D.etal.EurHeartJ200728:2937-2943Age-adjustedincidencerates(A)andHRs(B)ofNODaccordingtobloodpressurecategory,stratifiedbybaselinebodymassindexTHEISSUESCONSEQUENCESOFNODCVDANDnon-CVDHOWDOANTIHYPERTENSIVEDRUGSEFFECTINCIDENCEOFNODANDCVDONSEQUENCES?HOWSHOULDNODEFFECTMANAGEMENTFORCVDPROTECTION?Non-CVDConsequencesofNODImpairedBPcontrolBehavioralandPsychologicalMicrovascularconsequences(?)MedicalcaredemandsTreatmentchangesCVDConsequencesShortandLongtermAntihypertensiveDrugRelated.Whelton,P.K.etal.ArchInternMed2005;165:1401-1409.ALLHATIncidenceofCoronaryheartdiseasebytreatmentgroupaccordingtobaselinediabetesmellitus,impairedfastingglucoselevel,ornormoglycemiaBarzilay,J.I.etalALLHAT.ArchInternMed2006;166:2191-2201.HR’sofa10-mg/dL(0.56-mm)FBGat2yearsforsubsequentCVDandRenalDisease

EffectofACEIsandARBsonCVDMortalitySource#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,etal.DiabetesCare28:2261-2266,2005Age-gender–adjustedintreatmentCVDandnon-CVDbybaselineFBGamonghypertensivepatients.Alderman,Hypertension.1999;33:1130-1134Myocardialinfarction(fatalandnonfatal)inhypertensivepatientsaccordingtoDMstatus

Aksnes,T.A.etal.Hypertension2007;50DiabetesIncidence-4Years

(follow-upFBS126mg/dLforthose<126mg/dLatbaseline)***p<.05comparedtochlorthalidoneALLHATJAMA2002;288:2981-2997Ramiprilv.PlaceboinhighriskpatientswithIGTatbaselineDream.NEJM;355:1551-1562,2006Ramiprilv.Placebo

CVD&non-CVDOutcomesDream.NEJM;355:1551-1562,2006.Whelton,P.K.etal.ArchInternMed2005;165:1401-1409.ALLHAT:RR(and6-yearratesper100fornondiureticcomparedwithdiureticfordiabetesmellitus(A),impairedfasingglucoselevel(B),andnormoglycemia(C)atbaseline,forCHD,all-causemortality,combinedCHD,stroke,HF,allCVD,andESRDCVdeath(%)PLACEBOACTIVE*=p<0.05vsnodiabetesSHEP-14YEARFOLLOW-UPCONCLUSIONSFROMSHEP+ChlorthalidoneRxofhypertensionimproveslong-termoutcomes.Thediabetesrelatedtochlorthalidonetherapyhasbetterprognosisthandiabetesatbaseline.Thebenefitofchlorthalidone-basedtherapyonlong-termtotalandCVmortalityismostpronouncedinhypertensivepatientswithdiabetes.

ReductioninmajorCVDamong6,000DMinHPSassociatedwith38/89LDL/CHOLbyStatinMazzone,T.TheAmericanJournalofMedicine120;2007,S26-S32

IncidenceofMIandMicrovascularEndpointsbyMeanSBPandHbA1cinUKPDSAdjustedincidence

per1000person-years(%)UpdatedmeanHbA1cconcentration(%)MeanSBP(mmHg)Adjustedincidence

per1000person-years(%)567891011110120130140150160170MyocardialinfarctionMicrovascular

endpointsMicrovascular

endpointsMyocardialinfarctionAdlerAI,etal.BMJ.2000;321:412-419.StrattonIM,etal.BMJ.2000;321:405-412..MI=myocardialinfarctionSBP=systolicbloodpressureUNCERTAINTYCONTINUES

ACCORDANDADVANCEACCORD-MortalitygreaterwithHbAlc<6.4v.7.0-7.9%ADVANCE-NoevidenceofmortalitywithHbAlc6.4v.7,5%MajorCVEventRateInHOTHOTLancet1998;351:1755<90<85<80<90<85<8085.283.281.1

DBPachievedp=0.00551%riskreductionGoalDiastolicmmHgDiabeticpopulationNon-DiabeticsubjectsCONCLUSIONSDMseriouswheneveritoccursMorecommoninhypertensiveRxParticularlywithdiureticsNODhasconsequencesNon-CVDinshorttermCVDlongtermNeitherfearof,norNOD,r