The George Institute for International Health, University of Sydney, New South Wales, Australia.
J Hypertens. 2010 Jun;28(6):1141-9.
The efficacy and safety of blood pressure lowering in elderly patients have not been sufficiently investigated in patients with diabetes. Using data from the Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation study, we assessed the efficacy and safety of routine blood pressure lowering to prevent major clinical outcomes in elderly patients with type 2 diabetes.
Eleven thousand one hundred and forty patients aged at least 55 years with type 2 diabetes (mean 66+/-6 years) were randomly assigned to perindopril-indapamide or placebo. The primary endpoint was a composite of major macrovascular and microvascular disease. The effects of active treatment on outcomes were estimated in subgroups according to age: below 65, 65-74 and at least 75 years.
During a mean 4.3-year follow-up, 1799 (16.1%) patients experienced a major event. Active treatment produced similar relative risk reductions for the primary outcome, major macrovascular disease, death and renal events across age groups (all P heterogeneity >0.3). Over 5 years, active treatment was estimated to prevent one primary outcome in every 21, 71 and 118 patients of at least 75, 65-74 and below 65 years, respectively. Similar patterns of benefits were observed for secondary outcomes. There were no differences in the tolerability between randomized allocations across age groups (all P heterogeneity >0.6)
Routine administration of perindopril-indapamide lowers blood pressure safely and reduces the risk of major clinical outcomes in patients of at least 75 years with type 2 diabetes. The greater absolute benefits in older patients in this age group were not offset by an increased risk of side effects.
在患有糖尿病的患者中，尚未充分研究降压治疗对老年患者的疗效和安全性。利用来自糖尿病和血管疾病的行动：预先和 diamicroN-MR 对照评估研究的数据，我们评估了常规降压治疗预防 2 型糖尿病老年患者主要临床结局的疗效和安全性。
11140 例年龄至少 55 岁的 2 型糖尿病患者（平均 66+/-6 岁）被随机分配至培哚普利吲达帕胺或安慰剂组。主要终点是主要大血管和微血管疾病的复合终点。根据年龄亚组（<65 岁、65-74 岁和≥75 岁）估计活性治疗对结局的影响。
在平均 4.3 年的随访期间，1799 例（16.1%）患者发生了主要事件。在所有年龄组中，活性治疗对主要结局、大血管疾病、死亡和肾脏事件的相对风险降低均相似（所有 P 异质性>0.3）。在 5 年内，估计每 21、71 和 118 例至少 75、65-74 和<65 岁的患者中，活性治疗可预防 1 例主要结局。次要结局也观察到类似的获益模式。在所有年龄组中，随机分组之间的耐受性差异无统计学意义（所有 P 异质性>0.6）。
常规应用培哚普利吲达帕胺可安全降压，并降低 2 型糖尿病至少 75 岁患者主要临床结局的风险。在该年龄组中，老年患者的绝对获益更大，但并未因副作用风险增加而抵消。
