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[高血压合并II型糖尿病患者的抗高血压治疗——当前临床研究]

[Antihypertensive treatment for patients with hypertension and diabetes type II--current clinical research].

作者信息

Rajzer Marek, Kawecka-Jaszcz Kalina, Wojciechowska Wiktoria

机构信息

I Klinika Kardiologii Collegium Medicum, Uniwersytet Jagieloński, 31-501 Kraków, ul. Kopernika 17.

出版信息

Przegl Lek. 2003;60(2):111-5.

Abstract

The frequency of arterial hypertension occurrence in polish population amounts to 30-40%, among diabetics is significantly higher-70%. According to the WHO/ISH Guidelines all hypertensive patients with diabetes are included into the "high risk group" independent of hypertension stage. Pharmacological treatment of hypertension is this group of patients has a particular meaning. Among hypertensive patients the degree of blood pressure lowering is more effective for cardiovascular risk reduction than choice of drug. This fact is well documented in clinical trials comparing antihypertensive efficacy of old and new antihypertensive drugs (for example UKPDS, STOP 2, INSIGHT). From the other point of view renal protection and metabolic benefits, as well as reduction of target organ damage are more advantageous for angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists and calcium antagonists than for diuretics and beta-blockers. Despite fast progress in clinical research on new antihypertensive drugs (especially AT1 receptor inhibitors) ACE-I seem to still remain still the "first choice" for hypertensive diabetics. Adequate blood pressure control among diabetic hypertensives is of special importance and usually needs appropriate combined antihypertensive therapy. Our review presents detailed information about treatment advantages and disadvantages of drugs from different antihypertensive classes in light of current clinical trials and international guidelines.

摘要

波兰人群中动脉高血压的发生率为30%-40%,在糖尿病患者中明显更高,达70%。根据世界卫生组织/国际高血压学会指南,所有糖尿病高血压患者均被纳入“高危组”,与高血压阶段无关。对这组患者进行高血压的药物治疗具有特殊意义。在高血压患者中,降低血压的程度对降低心血管风险比选择药物更有效。这一事实在比较新旧抗高血压药物抗高血压疗效的临床试验(如英国前瞻性糖尿病研究、斯德哥尔摩高血压2期研究、国际硝苯地平控释片治疗高血压干预试验)中有充分记录。从另一方面来看,与利尿剂和β受体阻滞剂相比,血管紧张素转换酶抑制剂、血管紧张素II受体拮抗剂和钙拮抗剂在肾脏保护和代谢益处以及减少靶器官损害方面更具优势。尽管新型抗高血压药物(尤其是AT1受体抑制剂)的临床研究进展迅速,但血管紧张素转换酶抑制剂似乎仍然是糖尿病高血压患者的“首选”。糖尿病高血压患者的血压得到充分控制尤为重要,通常需要适当的联合抗高血压治疗。我们的综述根据当前临床试验和国际指南,详细介绍了不同抗高血压类别药物的治疗优缺点。

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