Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
Section of Preventive Cardiology and Rehabilitation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code JB-1, Cleveland, OH, 44195, USA.
Curr Cardiol Rep. 2021 Jan 23;23(3):14. doi: 10.1007/s11886-021-01443-0.
Blood pressure guidelines worldwide have changed their recommended blood pressure goals multiple times over the past decade due to an evolving understanding of the treatment of hypertension in patients with diabetes mellitus. While it is evident through randomized trials that treatment of hypertension in diabetes mellitus prevents complications, the optimal blood pressure goal is not clear.
Post hoc analyses of the Action to Control Cardiovascular Risk in Diabetes-Blood Pressure (ACCORD-BP) trial, its long-term follow along study ACCORDION, and Systolic Blood Pressure Intervention Trial (SPRINT) suggest that patients with diabetes have a reduced risk of adverse cardiovascular events when aiming for more intensive blood pressure targets. High-quality data support guideline recommendations for more aggressive blood pressure targets in patients with diabetes mellitus. Reasoning for a return to more aggressive blood pressure goals in this at-risk population is discussed, and treatment strategies encompassing contemporary therapeutic options are recommended.
由于对糖尿病患者高血压治疗的理解不断发展，过去十年中，全球范围内的血压指南多次改变了其推荐的血压目标值。虽然随机试验显然表明，治疗糖尿病患者的高血压可预防并发症，但最佳血压目标值尚不清楚。
心血管风险控制行动中的糖尿病-血压（ACCORD-BP）试验、其长期随访研究 ACCORDION 以及收缩压干预试验（SPRINT）的事后分析表明，对于糖尿病患者，当目标血压值更严格时，其发生不良心血管事件的风险降低。高质量的数据支持指南建议对糖尿病患者采用更积极的血压目标值。讨论了为何要在这一高危人群中重新采用更积极的血压目标值的原因，并推荐了涵盖当代治疗选择的治疗策略。
