Pieske Burkert, Wachter Rolf
Department of Cardiology, Medical University of Graz, Graz, Austria.
Curr Opin Cardiol. 2008 Jul;23(4):340-9. doi: 10.1097/HCO.0b013e3283031ab3.
Hypertension and diabetes both contribute to cardiovascular disease. The purpose of this review is to summarize novel epidemiological and clinical insights into the risk continuum of blood pressure and abnormalities in glucose metabolism for cardiovascular adverse remodelling, summarize the current mechanistic knowledge on hypertensive heart disease and diabetic cardiomyopathy, outline the effects of hypertension and diabetes on diastolic dysfunction and heart failure with normal ejection fraction, and discuss novel therapeutic aspects in these disease entities.
The prevalence of diabetes mellitus and hypertension increases in western populations and largely contributes to adverse cardiovascular remodelling and the growing number of patients with heart failure. Recently, diastolic heart failure (i.e., heart failure with normal ejection fraction) has been recognized as a major adverse manifestation of hypertension and diabetes, but convincing therapeutic strategies other than strict risk factor control are still lacking. However, due to clearer definitions and novel noninvasive diagnostic techniques for heart failure with normal ejection fraction, future studies may better define new specific therapeutic approaches.
New insights into the epidemiology and pathophysiology of diabetes-associated and hypertension-associated cardiac alterations may open the field for novel preventive therapeutic strategies tailored to reduce the risk of heart failure in this large population at risk.
高血压和糖尿病均会导致心血管疾病。本综述旨在总结关于血压风险连续体和糖代谢异常与心血管不良重塑之间关系的新的流行病学和临床见解，总结目前关于高血压性心脏病和糖尿病性心肌病的机制知识，概述高血压和糖尿病对舒张功能障碍及射血分数正常的心力衰竭的影响，并讨论这些疾病实体的新治疗方面。
西方人群中糖尿病和高血压的患病率增加，这在很大程度上导致了不良心血管重塑以及心力衰竭患者数量的增加。最近，舒张性心力衰竭（即射血分数正常的心力衰竭）已被确认为高血压和糖尿病的主要不良表现，但除了严格控制危险因素外，仍缺乏令人信服的治疗策略。然而，由于对射血分数正常的心力衰竭有了更清晰的定义和新的非侵入性诊断技术，未来的研究可能会更好地确定新的特异性治疗方法。
对糖尿病相关和高血压相关心脏改变的流行病学和病理生理学的新见解可能为量身定制的新型预防治疗策略开辟领域，以降低这一大量高危人群发生心力衰竭的风险。
