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題名 | 糖尿病照護:高血壓之處理與治療=Standards of Medical Care in Diabetes: Hypertension Management and Treatment |
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作者 | 邱春吉; 戴慶玲; Chiou, Chun-chi; Tai, Ching-ling; |
期刊 | 藥學雜誌 |
出版日期 | 20190900 |
卷期 | 35:3=140 2019.09[民108.09] |
頁次 | 頁8-13 |
分類號 | 415.382 |
語文 | chi |
關鍵詞 | 高血壓; 糖尿病; ASCVD; ACEI; ARB; |
中文摘要 | 高血壓是引起粥狀動脈硬化心血管疾病 (ASCVD;atherosclerotic cardiovascular disease)、心衰竭、微血管併發症等疾病的強烈危險因子,很多研究顯示高血壓的控制 與治療,可預防或延緩糖尿病人 ASCVD 的進行,減少大小血管併發症的發生。隨機 臨床試驗與統合分析的實證支持,大部分成年糖尿病人之血壓控制目標值至少要小於 140/90 mmHg,然而對於高心血管疾病風險之糖尿病人,較低的血壓控制目標 (小於 130/80 mmHg) 相對是有益的。除了生活型態的調適外,為了達成血壓控制目標,通 常需要合併多種類藥物來治療。ACEI (angiotensin converting enzyme inhibitor)、ARB (angiotensin receptor blocker)、dihydropyridine CCB (calcium channel blocker)、thiazidelike diuretic 可改善臨床結果,是血壓控制的較優選項,而對於有蛋白尿的病人 ACEI 或 ARB 是首選。高血壓的治療將基於病人的共病症,預期減少大小血管併發症的好 處,發生不良事件的風險等個別化因素來考量。 |
英文摘要 | Hypertension is a strong risk factor for atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications. Numerous studies have shown that the control and therapy of hypertension in preventing or slowing ASCVD, reducing the macrovascular and microvascular complications in people with diabetes. Strong evidence from randomized clinical trials and meta-analyses supports targeting blood pressure reduction to at least < 140/90 mmHg in most adults with diabetes. Lower blood pressure targets (< 130/80 mmHg) may be beneficial for high cardiovascular disease risk. In addition to lifestyle modifications, multiple medication classes are often needed to attain blood pressure goals. ACEI (angiotensin converting enzyme inhibitor), ARB (angiotensin receptor blocker), dihydropyridine CCB (calcium channel blocker), thiazide-like diuretic have been demonstrated to improve clinical outcomes and are preferred for blood pressure control. For patients with albuminuria, ACEI or ARB should be first choice. Hypertension treatment should be individualized based on their comorbidities, their anticipated benefit for reduced the macrovascular and microvascular complications, and their risk of adverse events. |
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