抗高血压药物引起的糖尿病不容忽视英文

ACEI ARB
6
74,626 0.93(0.81-1.06)
5
34,426 0.93 (0.81-1.06)
HTN
7
86,414 0.99 (0.93--1.06)
Gillespie, et al. Diabetes Care 28:2261-2266, 2005
Age-gender–adjusted in treatment CVD and non-CVD by baseline FBG among
10
10
4
5
0
Geiss LS, et al. In: Diabetes in America. National Institutes of Health;1995.
Systolic BP and CV Death in MRFIT
250 225 200 175 150 125 100
75 50 25
Annual Incidence of Diabetes in Hypertensive Patients
• SHEP 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-up NOD in US Women by Baseline BP
10
9
8
7
5.79
6
5
4
2.97
3
2 1.47
1
0பைடு நூலகம்
mmHg <120 120-129
Conen, D. et al. Eur Heart J 2007 28:2937-2943
130-139
THE ISSUES
• CONSEQUENCES OF NOD
– CVD AND non-CVD
• HOW DO ANTIHYPERTENSIVE DRUGS EFFECT INCIDENCE OF NOD AND CVD ONSEQUENCES?
• HOW SHOULD NOD EFFECT MANAGEMENT FOR CVD PROTECTION?
hypertensive patients.
Alderman, Hypertension. 1999;33:1130-1134
Myocardial infarction (fatal and nonfatal) in hypertensive patients according to DM status
10
>140
Age-adjusted incidence rates (A) and HRs (B) of NOD according to blood pressure category, stratified by baseline body mass index
. Conen, D. et al. Eur Heart J 2007 28:2937-2943
mellitus, impaired fasting glucose level, or normoglycemia
Whe.lton, P. K. et al. Arch Intern Med 2005;165:1401-1409.
HR’s of a 10-mg/dL (0.56-mm) FBG at 2 years for subsequent CVD and Renal Disease
Barzilay, J. I. et al ALLHAT. Arch Intern Med 2006;166:2191-2201.
Effect of ACEIs and ARBs on CVD Mortality
Source # studies #subjects OR (95% CI)
All
11 109,052 0.96(0.91-1.01)
Non-CVD Consequences of NOD
• Impaired BP control • Behavioral and Psychological • Microvascular consequences (?) • Medical care demands • Treatment changes
National Survey (10) and 2000–2001 InterASIA Study
Gu et al Diabetologia. 2003;46:1190.
65% of Mortality in people with Diabetes is CVD
50
40
40
30
20
15
13
13
0
Nondiabetic (n=342,815) Diabetic (n=5,163)
<120 120-139140-159160-179180-199 200 Systolic BP (mmHg)
BP= blood pressure CV=cardiovascular MRFIT=Multiple Risk Factor Intervention Trial Stamler J, et al. Diabetes Care. 1993;16:434-444.
CVD Consequences
• Short and Long term • Antihypertensive Drug Related
ALLHAT Incidence of Coronary heart disease by treatment group according to baseline diabetes
DRUG INDUCED DIABETES DURING ANTIHYPERTENSIVE
THERAPY IS IMPORTANT - BUT
CHINESE SOCIETY OF HYPERTENSION
MICHAEL ALDERMAN MAY 22, 2008
Prevalence of diabetes among Chinese adults aged 35–64 years in the 1994 Chinese