Shaikh Altamash
Department of Endocrinology, Saifee Hospital, Mumbai, India.
Diabetes Ther. 2017 Oct;8(5):981-989. doi: 10.1007/s13300-017-0310-3. Epub 2017 Sep 19.
Hypertension is one of the most important comorbidities of diabetes, contributing significantly to death and disability and leads to macrovascular and microvascular complications. When assessing the medical priorities for patients with diabetes, treating hypertension should be a primary consideration. Practical approaches to hypertension in diabetes, including individualized targets are discussed, as per stage and complication of diabetes, according to current studies and guidelines. Angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARBs) are the most effective drugs for treating hypertension in diabetes, in the absence of contraindications. Calcium antagonists or diuretics are acceptable as second-line agents. Once the target is achieved, antihypertensive drugs should be continued. Newer antidiabetes medications such as sodium glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1-RA), and dipeptidyl peptidase-4 inhibitors (DPP4i) have antihypertensive properties and may assist in treatment decision-making.
高血压是糖尿病最重要的合并症之一,对死亡和残疾有显著影响,并导致大血管和微血管并发症。在评估糖尿病患者的医疗重点时,治疗高血压应是首要考虑因素。根据当前研究和指南,针对糖尿病不同阶段和并发症,讨论了糖尿病高血压的实用治疗方法,包括个体化目标。在没有禁忌证的情况下,血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体阻滞剂(ARB)是治疗糖尿病高血压最有效的药物。钙拮抗剂或利尿剂可作为二线药物。一旦达到目标,应继续使用抗高血压药物。新型抗糖尿病药物,如钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)、胰高血糖素样肽1受体激动剂(GLP1-RA)和二肽基肽酶4抑制剂(DPP4i)具有降压特性,可能有助于治疗决策。