Balfour Pelbreton C, Rodriguez Carlos J, Ferdinand Keith C
Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Curr Hypertens Rep. 2014 Aug;16(8):455. doi: 10.1007/s11906-014-0455-7.
Despite remarkable declines in US cardiovascular disease morbidity and mortality over the last several decades, the prevalence of risk factors such as type 2 diabetes and hypertension remains high, associated with increasing obesity rates. Although optimal glycemic control remains a primary focus to decrease the disease burden, the FDA has issued guidance recommendations for documenting cardiovascular disease-related safety with research trials on new antidiabetic agents with more demanding requirements compared to past approval of existing therapies. This review will discuss the public health impact of type 2 diabetes, specifically with comorbid hypertension; mechanisms of action of the newest antidiabetic drug classes; and preliminary findings and potential clinical significance of the favorable blood pressure and body weight effects of the sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists; and additionally discuss two recent large cardiovascular outcome trials with dipeptidyl peptidase-4 inhibitors.
尽管在过去几十年里美国心血管疾病的发病率和死亡率显著下降，但2型糖尿病和高血压等风险因素的患病率仍然很高，且与肥胖率上升有关。虽然最佳血糖控制仍然是减轻疾病负担的主要重点，但与过去批准现有疗法相比，美国食品药品监督管理局（FDA）已发布指导建议，要求通过对新型抗糖尿病药物进行研究试验来记录与心血管疾病相关的安全性，其要求更为严格。本综述将讨论2型糖尿病对公共卫生的影响，特别是合并高血压的情况；最新抗糖尿病药物类别的作用机制；钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽1受体激动剂对血压和体重产生有利影响的初步研究结果及潜在临床意义；此外还将讨论两项最近使用二肽基肽酶-4抑制剂的大型心血管结局试验。
