Gnanenthiran Sonali R, Webster Ruth, Silva Asita de, Maulik Pallab K, Salam Abdul, Selak Vanessa, Guggilla Rama K, Schutte Aletta E, Patel Anushka, Rodgers Anthony
The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
School of Population Health, UNSW, Sydney, Australia.
Hypertens Res. 2023 Jan;46(1):128-135. doi: 10.1038/s41440-022-01051-7. Epub 2022 Oct 14.
We investigated whether diabetes mellitus (DM) affects the efficacy of a low-dose triple combination pill and usual care among people with mild-moderate hypertension. TRIUMPH (TRIple pill vs Usual care Management for Patients with mild-to-moderate Hypertension) was a randomised controlled open-label trial of patients requiring initiation or escalation of antihypertensive therapy. Patients were randomised to a once-daily low-dose triple combination polypill (telmisartan-20mg/amlodipine-2.5 mg/chlorthalidone-12.5 mg) or usual care. This analysis compared BP reduction in people with and without DM, both in the intervention and control groups over 24-week follow-up. Predicted efficacy of prescribed therapy was calculated (estimation methods of Law et al.). The trial randomised 700 patients (56 ± 11 yrs, 31% DM). There was no difference in the number of drugs prescribed or predicted efficacy of therapy between people with DM and without DM. However, the observed BP reduction from baseline to week 24 was lower in those with DM compared to non-diabetics in both the triple pill (25/11 vs 31/15 mmHg, p ≤ 0.01) and usual care (17/7 vs 22/11 mmHg, p ≤ 0.01) groups, and these differences remained after multivariable adjustment. DM was a negative predictor of change in BP (β-coefficient -0.08, p = 0.02). In conclusion, patients with DM experienced reduced efficacy of BP lowering therapies as compared to patients without DM, irrespective of the type of BP lowering therapy received.
我们调查了糖尿病（DM）是否会影响低剂量三联复方药丸和常规护理对轻中度高血压患者的疗效。TRIUMPH（轻度至中度高血压患者三联药丸与常规护理管理）是一项针对需要启动或强化降压治疗患者的随机对照开放标签试验。患者被随机分为每日一次低剂量三联复方药丸（替米沙坦20毫克/氨氯地平2.5毫克/氯噻酮12.5毫克）组或常规护理组。该分析比较了干预组和对照组中糖尿病患者和非糖尿病患者在24周随访期间的血压降低情况。计算了规定治疗的预测疗效（采用Law等人的估计方法）。该试验随机分配了700名患者（年龄56±11岁，31%患有糖尿病）。糖尿病患者和非糖尿病患者在处方药物数量或治疗预测疗效方面没有差异。然而，在三联药丸组（25/11对31/15 mmHg，p≤0.01）和常规护理组（17/7对22/11 mmHg，p≤0.01）中，糖尿病患者从基线到第24周观察到的血压降低幅度均低于非糖尿病患者，并且在多变量调整后这些差异仍然存在。糖尿病是血压变化的负向预测因素（β系数-0.08，p = 0.02）。总之，与非糖尿病患者相比，糖尿病患者降压治疗的疗效降低，无论接受何种类型的降压治疗。
