Estacio R O, Jeffers B W, Gifford N, Schrier R W
Department of Medicine, Colorado Prevention Center, Denver, USA.
Diabetes Care. 2000 Apr;23 Suppl 2:B54-64.
The Appropriate Blood Pressure Control in Diabetes (ABCD) Trial is a prospective randomized blinded clinical trial that compares the effects of intensive versus moderate blood pressure control on the incidence and progression of type 2 diabetic complications. The current article discusses the results of 5.3 years of follow-up of 470 patients with hypertension and evaluates the effects of intensive and moderate blood pressure therapy using nisoldipine versus enalapril as the initial antihypertensive medication for nephropathy, retinopathy, and neuropathy.
The 470 hypertensive subjects, defined as having a baseline diastolic blood pressure of > or = 90 mmHg, were randomized to intensive blood pressure control (diastolic blood pressure goal of 75 mmHg) versus moderate blood pressure control (diastolic blood pressure goal of 80-89 mmHg).
The mean blood pressure achieved was 132/78 mmHg in the intensive group and 138/86 mmHg in the moderate control group. During the 5-year follow-up period, no difference was observed between intensive versus moderate blood pressure control and those randomized to nisoldipine versus enalapril with regard to the change in creatinine clearance. After the first year of antihypertensive treatment, creatinine clearance stabilized in both the intensive and moderate blood pressure control groups in those patients with baseline normo- or microalbuminuria. In contrast, patients starting with overt albuminuria demonstrated a steady decline in creatinine clearance of 5-6 ml.min-1.1.73 m-2 per year throughout the follow-up period whether they were on intensive or moderate therapy. There was also no difference between the interventions with regard to individuals progressing from normoalbuminuria to microalbuminuria (25% intensive therapy vs. 18% moderate therapy, P = 0.20) or microalbuminuria to overt albuminuria (16% intensive therapy vs. 23% moderate therapy, P = 0.28). Intensive therapy demonstrated a lower overall incidence of deaths, 5.5 vs. 10.7%, P = 0.037. Over a 5-year follow-up period, there was no difference between the intensive and moderate groups with regard to the progression of diabetic retinopathy and neuropathy. In addition, the use of nisoldipine versus enalapril had no differential effect on diabetic retinopathy and neuropathy.
Blood pressure control of 138/86 or 132/78 mmHg with either nisoldipine or enalapril as the initial antihypertensive medication appeared to stabilize renal function in hypertensive type 2 diabetic patients without overt albuminuria over a 5-year period. The more intensive blood pressure control decreased all-cause mortality.
糖尿病患者血压适度控制（ABCD）试验是一项前瞻性随机双盲临床试验，比较强化血压控制与适度血压控制对2型糖尿病并发症发生率和进展的影响。本文讨论了470例高血压患者5.3年的随访结果，并评估了使用尼索地平与依那普利作为肾病、视网膜病变和神经病变初始抗高血压药物的强化和适度血压治疗的效果。
470名高血压受试者，定义为基线舒张压≥90 mmHg，被随机分为强化血压控制组（舒张压目标为75 mmHg）和适度血压控制组（舒张压目标为80 - 89 mmHg）。
强化组平均血压为132/78 mmHg，适度控制组为138/86 mmHg。在5年随访期内，强化与适度血压控制之间以及随机接受尼索地平与依那普利治疗的患者在肌酐清除率变化方面未观察到差异。在抗高血压治疗的第一年之后，基线为正常或微量白蛋白尿的患者，强化和适度血压控制组的肌酐清除率均稳定。相比之下，起始为显性白蛋白尿的患者，无论接受强化治疗还是适度治疗，在整个随访期内肌酐清除率均以每年5 - 6 ml·min⁻¹·1.73 m⁻²的速度稳步下降。从正常白蛋白尿进展为微量白蛋白尿（强化治疗组为25%，适度治疗组为18%，P = 0.20）或从微量白蛋白尿进展为显性白蛋白尿（强化治疗组为16%，适度治疗组为23%，P = 0.28）方面，干预措施之间也没有差异。强化治疗组的总死亡率较低，分别为5.5%和10.7%，P = 0.037。在5年随访期内，强化组和适度组在糖尿病视网膜病变和神经病变的进展方面没有差异。此外，使用尼索地平与依那普利对糖尿病视网膜病变和神经病变没有差异影响。
以尼索地平或依那普利作为初始抗高血压药物，将血压控制在138/86或132/78 mmHg，在5年期间似乎能使无显性白蛋白尿的高血压2型糖尿病患者的肾功能稳定。更强化的血压控制降低了全因死亡率。
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