Os Ingrid, Gudmundsdottir Helga, Kjeldsen Sverre E, Oparil Suzanne
Faculty Division Ulleval, School of Medicine, University of Oslo, Oslo, Norway.
Diabetes Obes Metab. 2006 Jul;8(4):381-7. doi: 10.1111/j.1463-1326.2005.00523.x.
Age-related arterial stiffness is more pronounced in diabetics compared to non-diabetics, which could explain the prevalence of isolated systolic hypertension (ISH, systolic blood pressure > or =140 mmHg and diastolic blood pressure <90 mmHg) being approximately twice that of the general population without diabetes. Large-scale interventional outcome trials have also shown that diabetics usually have higher pulse pressure and higher systolic blood pressure than non-diabetics. Advanced glycation end-product formation has been implicated in vascular and cardiac complications of diabetes including loss of arterial elasticity, suggesting possibilities for new therapeutic options. With increasing age, there is a shift to from diastolic to systolic blood pressure and pulse pressure as predictors of cardiovascular disease. This may affect drug treatment as different antihypertensive drugs may have differential effects on arterial stiffness that can be dissociated from their effects on blood pressure. While thiazide diuretics are associated with little or no change in arterial stiffness despite a robust antihypertensive effect, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and calcium-channel blockers have been shown to reduce arterial stiffness. However, combination therapy is nearly always necessary to obtain adequate blood pressure control in diabetics. There are no randomized controlled trials looking specifically at treatment of ISH in diabetics. Recommendations regarding treatment of ISH in diabetes mellitus type 2 are based on extrapolation from studies in non-diabetics, post-hoc analyses and prespecified subgroup analysis in large-scale studies, and metaanalysis. These analyses have clearly demonstrated that blood pressure lowering in ISH confers improved prognosis and reduced cardiovascular and renal outcomes in both diabetics and non-diabetics.
与非糖尿病患者相比，年龄相关的动脉僵硬度在糖尿病患者中更为明显，这可以解释单纯收缩期高血压（ISH，收缩压≥140 mmHg且舒张压<90 mmHg）的患病率约为非糖尿病普通人群的两倍。大规模干预性结局试验也表明，糖尿病患者通常比非糖尿病患者具有更高的脉压和收缩压。晚期糖基化终产物的形成与糖尿病的血管和心脏并发症有关，包括动脉弹性丧失，这提示了新治疗选择的可能性。随着年龄的增长，作为心血管疾病预测指标的血压从舒张压转向收缩压和脉压。这可能会影响药物治疗，因为不同的抗高血压药物对动脉僵硬度可能有不同的影响，且这种影响可能与其对血压的影响无关。虽然噻嗪类利尿剂尽管有强大的降压作用，但与动脉僵硬度的变化很小或没有变化有关，但血管紧张素转换酶抑制剂、血管紧张素II受体阻滞剂和钙通道阻滞剂已被证明可降低动脉僵硬度。然而，在糖尿病患者中几乎总是需要联合治疗才能获得足够的血压控制。目前尚无专门针对糖尿病患者ISH治疗的随机对照试验。关于2型糖尿病患者ISH治疗的建议基于对非糖尿病患者研究的推断、事后分析、大规模研究中的预先指定亚组分析以及荟萃分析。这些分析清楚地表明，降低ISH患者的血压可改善糖尿病患者和非糖尿病患者的预后，并减少心血管和肾脏疾病的发生。
