Arauz-Pacheco C, Raskin P
Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, USA.
Endocrinol Metab Clin North Am. 1996 Jun;25(2):401-23. doi: 10.1016/s0889-8529(05)70330-3.
Hypertension should be detected and treated early in diabetic patients. It has a marked contribution to the morbidity and mortality of diabetic individuals due to both atherosclerosis and microvascular disease. Antihypertensive treatment is an effective tool in slowing the progression of early and advanced diabetic nephropathy. Prospective studies addressing the effects of antihypertensive regimens on the incidence of CHF, stroke, and coronary artery disease in the diabetic population are not available. We assume that the beneficial effects of therapy apply to both diabetic and nondiabetic subjects. Glycemic control and the lipid profile are major concerns when selecting an antihypertensive drug. Because hyperinsulinemia and insulin resistance have been advocated as hypertensive and atherosclerotic risk factors, the effects of antihypertensive drugs on insulin action and plasma insulin levels may also become an important element in the selection of an antihypertensive agent. ACE inhibitors, calcium channel blockers, and alpha-adrenergic blockers probably offer the most favorable metabolic profile when compared with diuretics and beta-blockers and should be used as the initial drugs in most clinical settings.
糖尿病患者的高血压应尽早发现并治疗。由于动脉粥样硬化和微血管疾病，高血压对糖尿病患者的发病率和死亡率有显著影响。抗高血压治疗是减缓早期和晚期糖尿病肾病进展的有效手段。目前尚无前瞻性研究探讨抗高血压治疗方案对糖尿病患者心力衰竭、中风和冠状动脉疾病发病率的影响。我们假定该治疗的有益效果适用于糖尿病和非糖尿病患者。选择抗高血压药物时，血糖控制和血脂情况是主要考虑因素。由于高胰岛素血症和胰岛素抵抗被认为是高血压和动脉粥样硬化的危险因素，抗高血压药物对胰岛素作用和血浆胰岛素水平的影响也可能成为选择抗高血压药物的重要因素。与利尿剂和β受体阻滞剂相比，血管紧张素转换酶抑制剂、钙通道阻滞剂和α肾上腺素能阻滞剂可能具有最有利的代谢特征，在大多数临床情况下应作为初始用药。
