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頁籤選單縮合
題名 | 糖尿病患的高血壓治療新趨勢=New Trend in Antihypertensive Treatment in Diabetes Mellitus |
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作者 | 傅振宗; 楊文琴; | 書刊名 | 內科學誌 |
卷期 | 13:5 2002.10[民91.10] |
頁次 | 頁215-224 |
分類號 | 415.668 |
關鍵詞 | 糖尿病; 高血壓治療; Diabetes mellitus; Antihypertensive treatment; |
語文 | 中文(Chinese) |
中文摘要 | 美國國家腎臟基金會與糖尿病學會將糖尿病患的血壓控制目標定在130/8OmmHg以下,至於合併腎臟病變,每日蛋白尿排出量大於1g病患,則以125/75mmHg以下作為控制目標。一般高血壓病患的藥物治療,優先考慮使用利尿劑與β阻斷劑,但是糖尿病常常合併高血脂,而降血壓藥物會影響血糖和血脂,因此過去選擇降血壓藥物時,主要是避免血糖和血脂肪惡化,但是目前實證醫學更重視藥物治療對於大血管病變和小血管病變的影響,尤其是在心血管疾病與腎臟病變方面,目前美國糖尿病學會建議,如果血壓在130-139/80-89mmHg之間,可以先接受最多3個月的行為治療,若血壓在140/9OmmHg以上,就必需馬上接受藥物治療,有微白蛋白尿或心血管危險因子的病患,第一線藥物以昇壓素轉化 抑制劑(ACEI)優先,至於美國國家腎臟基金會建議,如果血壓超過145/9OmmHg(超過控制目標15/1OmmHg)以上時,可以考慮合併使用ACEI與利尿劑,然後逐漸增加ACEI的劑量,若血壓仍高,則加上長效型鈣離子阻斷劑;倘若仍然無法將血壓控制在目標區,如果病患心跳每分鐘大於84次,可以考慮加上β阻斷劑,如果病患心跳每分鐘小於84次,則加上其他族群的鈣離子阻斷劑;至於α阻斷劑可以作為第四線藥物。 |
英文摘要 | New treatment guideline published by the National Kidney Foundation and American Diabetic Association advise physicians to lower the blood pressure of patients with diabetes to <130/80mmHg and even lower blood pressures levels -- less than 125/75 mm Hg for people who have proteinuria of greater than 1 g per day and renal insufficiency regardless of etiology. Although some antihypertensive medications have impacts on the patients' blood sugar and lipids, the evidence-based medicine put more focuses on reducing the morbidity and mortality from macrovascular (congestive heart failure, coronary artery disease, and stroke) and microvascular complications (nephropathy, neuropathy, and retinopathy). If the patient has a blood pressure above 145/90mmHg, starts treatment with low dose of an angiotensin-converting enzyme inhibitor and add a thiazide diuretic if necessary, then increasing the dosage of the ACE inhibitor, as needed. If blood pressure is still not controlled, add a nondihydropyridine calcium channel blocker is recommended. If the blood pressure goal is still not achieved, a beta blocker or other subgroup of calcium channel blocker can be added depending on the heart rate of the patient. Finally, once the goal of blood pressure is achieved, switch to a fixed-dose multi-drug combination of either an ACE inhibitor and a diuretic, to help facilitate patient compliance. |
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