Fuller J H
Department of Epidemiology and Public Health, University College, London, England.
J Cardiovasc Pharmacol. 1993;21 Suppl 2:S63-6.
Elevated blood pressure (BP) is an important risk factor for both the large- and small-vessel complications of diabetes. The following pathogenetic mechanisms have been proposed to explain the association between hypertension and diabetes: increases in total body exchangeable sodium associated with hyperglycemia, alterations in the function of the renin-angiotensin-aldosterone system, and the possible role of insulin resistance. Several prospective studies have shown that both systolic and diastolic BP are important predictors of ischemic heart disease, stroke, and renal disease mortality in diabetic patients. In spite of this strong association, there is little evidence from randomized controlled trials on the efficacy of BP lowering in the prevention of cardiovascular mortality in diabetic patients. Prospective data from the WHO Multinational Study do not provide clear evidence of benefit from treating diastolic BP < 95-100 mm Hg in patients with noninsulin-dependent diabetes.
血压升高是糖尿病大血管和小血管并发症的重要危险因素。以下发病机制已被提出用于解释高血压与糖尿病之间的关联：与高血糖相关的全身可交换钠增加、肾素-血管紧张素-醛固酮系统功能改变以及胰岛素抵抗的可能作用。几项前瞻性研究表明，收缩压和舒张压都是糖尿病患者缺血性心脏病、中风和肾病死亡率的重要预测指标。尽管存在这种强关联，但随机对照试验几乎没有证据表明降低血压对预防糖尿病患者心血管死亡率有效。世界卫生组织多国研究的前瞻性数据并未提供明确证据表明，对于非胰岛素依赖型糖尿病患者，将舒张压降至<95-100 mmHg能带来益处。
