Division of Cardiovascular Medicine and Department of Pharmacy Services, Brigham and Women's Hospital, Boston, Massachusettes.
Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, Virginia.
Diabetes Obes Metab. 2018 Jun;20(6):1499-1502. doi: 10.1111/dom.13248. Epub 2018 Mar 2.
Although guidelines recommend strict blood pressure (BP) control in patients with type 2 diabetes mellitus (T2DM) and elevated cardiovascular risk, the long-term effects of this approach are unknown. We investigated the effect of intensive BP control on clinical outcomes in patients with T2DM over 9 years of follow-up. We included Action to Control Cardiovascular Risk in Diabetes - Blood Pressure participants in the standard glucose control arm who had established cardiovascular disease, chronic kidney disease, were ≥75 years of age or who had a 10-year coronary heart risk ≥15%. Participants were randomized to either intensive (systolic BP < 120 mm Hg) or standard (systolic BP < 140 mm Hg) BP control for an average of 5 years. Observational follow-up occurred for an average of 4 years thereafter. After an average total follow-up of 9 years, intensive BP control reduced the composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke by 25% (hazard ratio, 0.75; 95% confidence interval, 0.60-0.95; P = .02). The overall benefit was driven by a reduction in nonfatal myocardial infarction (P = .01). In this post-hoc analysis, the benefits of a fixed-duration intensive BP control intervention in patients with T2DM persisted throughout 9 years of follow-up.
尽管指南建议 2 型糖尿病（T2DM）和心血管风险升高的患者严格控制血压（BP），但这种方法的长期效果尚不清楚。我们研究了强化 BP 控制对 9 年随访期间 T2DM 患者临床结局的影响。我们纳入了心血管风险控制行动-糖尿病-血压研究中标准血糖控制组的患者，他们患有已确诊的心血管疾病、慢性肾脏病、年龄≥75 岁或 10 年冠心病风险≥15%。参与者被随机分配到强化（收缩压<120mmHg）或标准（收缩压<140mmHg）BP 控制组，平均随访 5 年。此后平均进行了 4 年的观察性随访。在平均 9 年的总随访后，强化 BP 控制使心血管死亡、非致死性心肌梗死和非致死性卒中的复合终点降低了 25%（风险比，0.75；95%置信区间，0.60-0.95；P=0.02）。整体获益主要归因于非致死性心肌梗死的减少（P=0.01）。在这项事后分析中，T2DM 患者固定时长的强化 BP 控制干预的获益在 9 年的随访期间持续存在。
