Department of Internal Medicine, University of Perugia, Via E. Dal Pozzo, 06126, Perugia, Italy.
Curr Atheroscler Rep. 2011 Apr;13(2):176-85. doi: 10.1007/s11883-011-0160-9.
Diabetes and its micro- and macrovascular complications represent a worldwide epidemic that will place an enormous financial burden on poorer countries in the years to come. In patients with diabetes and hypertension, the main determinant of the cardiovascular and renal benefits of antihypertensive drugs is the blood pressure (BP) level achieved under treatment. Quite recently, the paradigm of a BP target < 130/80 mm Hg in these patients has been questioned by a number of trials, including data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure-lowering arm and from the diabetic cohort of International Verapamil SR-Trandolapril Study (INVEST). At the same time, even if the key role of BP control is unquestionable, a growing number of published trials suggest that different antihypertensive combinations may offer specific cardio-, vasculo-, and renoprotective advantages that go beyond BP reduction per se. The present review focuses on the most recent and important literature that explored the "optimal" antihypertensive therapy in patients with type 2 diabetes and concomitant hypertension, and it discusses in detail the various areas of uncertainty, including the specific renoprotective effects of renin-angiotensin system blocking agents and the long-term effects of angiotensin-converting enzyme/angiotensin receptor blocker combinations on the progression of diabetic nephropathy.
糖尿病及其微血管和大血管并发症是一种全球性的流行疾病，在未来几年将给较贫穷国家带来巨大的财政负担。在患有糖尿病和高血压的患者中，降压药物对心血管和肾脏的益处的主要决定因素是治疗下达到的血压（BP）水平。就在最近，一些试验对这些患者的血压目标<130/80mmHg 提出了质疑，其中包括来自心血管风险控制行动（ACCORD）降压臂的糖尿病患者的数据和国际维拉帕米 SR-盐酸地尔硫卓研究（INVEST）的糖尿病队列的数据。同时，即使血压控制的关键作用是毋庸置疑的，但越来越多的已发表试验表明，不同的降压联合治疗可能提供超越单纯降压本身的特定心脏、血管和肾脏保护优势。本综述重点关注了最近探讨 2 型糖尿病合并高血压患者“最佳”降压治疗的最重要文献，并详细讨论了各种不确定领域，包括肾素-血管紧张素系统阻滞剂的具体肾脏保护作用以及血管紧张素转换酶/血管紧张素受体阻滞剂联合治疗对糖尿病肾病进展的长期影响。
