Barnett A H
University of Birmingham, Birmingham Heartlands Hospital, UK.
Br Med Bull. 1994 Apr;50(2):397-407. doi: 10.1093/oxfordjournals.bmb.a072899.
Hypertension is about twice as common in diabetics as in non-diabetics. The increased prevalence may relate to insulin resistance and its sequelae. Hypertension is a major risk factor for both large and small vessel disease, contributing to accelerated atherogenesis and progression of diabetic nephropathy and retinopathy. Treating raised blood pressure in diabetics is beneficial in the context of large vessel disease and in slowing progression of overt nephropathy. There is controversy as to whether antihypertensives, and particularly ACE inhibitor drugs, will prevent progression from incipient to overt nephropathy. All the major classes of antihypertensives can be used in diabetics, but the thiazide diuretics and beta-blockers have metabolic side-effects which make them less appropriate as first line agents. The calcium antagonists and ACE inhibitors have better metabolic profiles and the latter reduce insulin resistance. ACE inhibitors may also have a renal protective effect in incipient nephropathy although the studies have been fairly short-term and with small patient numbers. Although ACE inhibitors and calcium antagonists are suitable as first line antihypertensives in diabetics, evidence is still lacking that these drugs reduce morbidity and mortality over and above that seen with other antihypertensives.
高血压在糖尿病患者中的发生率约为非糖尿病患者的两倍。患病率增加可能与胰岛素抵抗及其后果有关。高血压是大血管和小血管疾病的主要危险因素，会加速动脉粥样硬化的发展，并促使糖尿病肾病和视网膜病变进展。在糖尿病患者中治疗高血压对大血管疾病有益，且有助于延缓显性肾病的进展。关于抗高血压药物，尤其是血管紧张素转换酶（ACE）抑制剂类药物能否预防从早期肾病发展为显性肾病，目前存在争议。所有主要类型的抗高血压药物均可用于糖尿病患者，但噻嗪类利尿剂和β受体阻滞剂具有代谢副作用，不太适合作为一线用药。钙拮抗剂和ACE抑制剂具有较好的代谢特性，后者还能降低胰岛素抵抗。ACE抑制剂在早期肾病中可能也具有肾脏保护作用，不过相关研究的时间较短且患者数量较少。虽然ACE抑制剂和钙拮抗剂适合作为糖尿病患者的一线抗高血压药物，但仍缺乏证据表明这些药物能比其他抗高血压药物更多地降低发病率和死亡率。
