Petrella Robert J, Gill Dawn P, Berrou Jean-Pascal
Departments of Family Medicine, Medicine (Cardiology) and Kinesiology, University of Western Ontario, London, ON, Canada ; Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada ; Department of Family Medicine and School of Health Studies, University of Western Ontario, London, ON, Canada.
Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada ; Department of Family Medicine and School of Health Studies, University of Western Ontario, London, ON, Canada.
Diabetes Metab Syndr Obes. 2015 Mar 24;8:173-80. doi: 10.2147/DMSO.S79221. eCollection 2015.
As part of the Physicians' Observational Work on Patient Education According to their Vascular Risk (POWER) survey, we used Framingham methodology to examine the effect of an eprosartan-based regimen on total coronary heart disease (CHD) risk in diabetic patients recruited in Canada.
Patients with new or uncontrolled hypertension (sitting systolic blood pressure [SBP] >140 mmHg with diastolic blood pressure <110 mmHg) were identified at 335 Canadian primary care practices. Initial treatment consisted of eprosartan 600 mg/day, which was later supplemented with other antihypertensives as required. Outcomes included change in SBP at 6 months (primary objective) and absolute change in the Framingham 10-year CHD risk score (secondary objective).
We identified an intention-to-treat diabetes population of 195 patients. Most diabetic patients were prescribed two or more antihypertensive drugs throughout the survey. Mean reductions in SBP and diastolic blood pressure were 20.8±14.8 mmHg and 9.5±10.7 mmHg, respectively. The overall absolute mean 10-year CHD risk, calculated using Framingham formulae, declined by 2.9±3.5 points (n=49). Average baseline risk was higher in men than women (14.8±8.6 versus 5.6±1.8 points); men also had a larger average risk reduction (4.2±4.3 versus 1.5±1.3 points). The extent of absolute risk reduction also increased with increasing age (trend not statistically significant).
Eprosartan-based therapy substantially reduced arterial blood pressure in our subset of diabetic patients; while there was a slight reduction in Framingham risk, there are indications from our data that both blood pressure control and the wider management of CHD risk in diabetic patients remains suboptimal in Canadian primary care.
作为医生根据血管风险进行患者教育观察工作（POWER）调查的一部分，我们采用弗雷明汉姆方法，研究以依普罗沙坦为基础的治疗方案对在加拿大招募的糖尿病患者的冠心病（CHD）总风险的影响。
在加拿大335家初级保健机构中识别出新发或血压控制不佳（坐位收缩压[SBP]>140 mmHg且舒张压<110 mmHg）的患者。初始治疗为依普罗沙坦600 mg/天，随后根据需要补充其他抗高血压药物。结局指标包括6个月时SBP的变化（主要目标）和弗雷明汉姆10年CHD风险评分的绝对变化（次要目标）。
我们确定了195例意向性治疗糖尿病患者。在整个调查过程中，大多数糖尿病患者被处方两种或更多种抗高血压药物。SBP和舒张压的平均降幅分别为20.8±14.8 mmHg和9.5±10.7 mmHg。使用弗雷明汉姆公式计算的总体绝对平均10年CHD风险下降了2.9±3.5分（n = 49）。男性的平均基线风险高于女性（14.8±8.6对5.6±1.8分）；男性的平均风险降低幅度也更大（4.2±4.3对1.5±1.3分）。绝对风险降低程度也随年龄增加而增加（趋势无统计学意义）。
在我们的糖尿病患者亚组中，以依普罗沙坦为基础的治疗可显著降低动脉血压；虽然弗雷明汉姆风险略有降低，但我们的数据表明，在加拿大初级保健中，糖尿病患者的血压控制和CHD风险的更广泛管理仍未达到最佳状态。
