Service de pharmacotoxicologie, hospices civils de Lyon, CHU de Lyon, 69424 Lyon, France; CNRS, laboratoire de biométrie et biologie évolutive UMR5558, université Lyon, université Lyon 1, 69622 Villeurbanne, France.
CNRS, laboratoire de biométrie et biologie évolutive UMR5558, université Lyon, université Lyon 1, 69622 Villeurbanne, France.
Diabetes Metab. 2019 Dec;45(6):550-556. doi: 10.1016/j.diabet.2019.05.003. Epub 2019 May 28.
Recent US recommendations indicate a target blood pressure (BP) of 130/80mmHg for patients with type 2 diabetes (T2D). Our aim was to characterize the association between risk of cardiovascular events and differences in BP decreases in randomized trials of a T2D population.
A systematic search was made for randomized clinical trials assessing the effects of antihypertensive treatments in T2D patients on mortality, and fatal and non-fatal cardiovascular events, using a meta-regression technique to explore the influence of BP decreases on treatment effects.
A total of 88,503 patients from 44 randomized trials were included. There was no significant association between BP decreases and risk of all-cause or cardiovascular mortality, cardiovascular events or myocardial infarction. However, stroke risk was influenced by BP decreases: compared with no reduction, a 10-mmHg reduction in systolic BP was associated with a relative odds ratio (OR) decrease of 33% (OR: 0.67, 95% CI: 0.54-0.82), and a 5-mmHg diastolic BP reduction was associated with a relative OR decrease of 38% (OR: 0.62, 95% CI: 0.50-0.76). Restricting the analysis to double-blind studies did not change the results for diastolic BP.
A reduction in BP lowers the risk of stroke, but does not appear to affect the risk of other cardiovascular events in a T2D population.
最近美国的建议指出，2 型糖尿病（T2D）患者的目标血压（BP）应为 130/80mmHg。我们的目的是描述 T2D 人群随机试验中 BP 降低与心血管事件风险之间的关系。
使用荟萃回归技术，对评估 T2D 患者抗高血压治疗对死亡率以及致命和非致命心血管事件影响的随机临床试验进行了系统检索，以探讨 BP 降低对治疗效果的影响。
共有来自 44 项随机试验的 88,503 名患者纳入研究。BP 降低与全因或心血管死亡率、心血管事件或心肌梗死风险之间无显著相关性。然而，BP 降低与卒中风险相关：与无降低相比，收缩压降低 10mmHg 与相对优势比（OR）降低 33%相关（OR：0.67，95%CI：0.54-0.82），舒张压降低 5mmHg 与相对 OR 降低 38%相关（OR：0.62，95%CI：0.50-0.76）。将分析仅限于双盲研究并未改变舒张压的结果。
BP 降低可降低卒中风险，但似乎不会影响 T2D 人群中其他心血管事件的风险。
