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頁籤選單縮合
題名 | 從JNCVI及UKPDS談第二型糖尿病的血壓控制=Blood Pressure Control in Type 2 Diabetes Mellitus: The Implications of JNCVI and UKPDS |
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作者 | 曾慶孝; | 書刊名 | 中華民國家庭醫學雜誌 |
卷期 | 8:3 1998.09[民87.09] |
頁次 | 頁103-109 |
分類號 | 415.6681 |
關鍵詞 | 第二型糖尿病; 血壓控制; 高血壓; Type 2 diabetes mellitus; Blood pressure control; Diabetic chronic complications; Cardiovascular disease; |
語文 | 中文(Chinese) |
中文摘要 | 糖尿病與高血壓的關係相當密切。二者及其所併發的疾病都是臺灣主要死亡原因,因此如何有效控制糖尿病病人合併的高血壓一直是國內外所關注的主題。美國國家衛生院發表的第六版「高血壓之預防、偵測、評估及治療準則」將高血壓定義值≧ 140/90 mmHg,或在服用抗高血壓藥物者,並將高血壓分為三期和將病人歸類為三個危險族群。針對病人不同的血壓值和危險性,他們做了不同的治療建議。該準則中將糖尿病的存在列為最高危險族群,因此建議及早給予藥物控制,並將血壓控制在130/85 mmHg以下。在藥物的選擇上,他們並未做硬性的規定。雖然針對未有合併症的高血壓患者他們建議啟始的治療藥物為利尿劑及貝它阻斷劑,但醫師可視病人的個別狀況和需求而做有彈性的選擇。「英國前瞻性糖尿病研究」於一九九八年同時發表了兩篇有關第二型糖尿病的嚴格血壓控制和併發症之相關性和比較二種藥物利弊的長期、隨機分配和對照試驗。該試驗結果指出嚴格的血壓控制可有效地預防糖尿病慢性併發症的發生。嚴格治療組的平均血壓值為144/82 mmHg,而較不嚴格控制組的血壓值為154/87 mmHg,兩者相差10/5 mmHg(p < 0.0001),但經長期追�j結果,前者相較於後者可有意義地減少24%的糖尿病相關終點事件,32% 的糖尿病相關死亡,44%的腦中風,和37% 的小血管終點事件。在進一步分析以captopril及atenolol嚴格控制的兩組時,發現前者的平均血壓為144/83 mmHg,而後者的平均血壓值為143/81 mmHg,兩者在血壓控制的成效上,及在終點事件和低血糖的發生上並無顯著之差異。由這些新近發表的文獻我們得到幾個結論:一、糖尿病為心臟血管疾病相當重要的危險因子;二、糖尿病併發高血壓時,必須將血壓值控制得更為嚴格;三、血壓的控制本身可能比藥物的選擇更為重要。 |
英文摘要 | Diabetes mellitus and hypertension are closely related. Both of them and their associated complications are the major causes of death in Taiwan. The presence of hypertension is a major risk factor associated with the mortality of diabetes mellitus. Treatment of hypertension in diabetic patients is a consistently attended issue and has been discussed in several reports recently. In 1997, the National Institute of Health of the USA released the Sixth Report of the Joint Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, suggesting that hypertension treatment has to be based on the stratification of blood pressures and risk groups. In this report, hypertension is defined as systolic blood pressure ≧ 140 mmHg, diastolic blood pressure ≧ 90 mmHg, or taking antihypertensive agents; and is classified into 3 categories of riks groups. The presence of diabetes mellitus is considered as the highest risk group and therefore, treatment of hypertension in diabetic patients is suggested to be given at an earlier stage. In addition, the goal of blood pressure control in diabetes mellitus is stricter, at a level below 130/85 mmHg. Although diuretics and β-blockers are recommended as starting pharmacologic therapy, the committee also recognizes the needs of clinical judgment on individual patient on choosing the medications. In 1998, the United Kingdom Prospective Diabetes Study Group released two papers determining whether tight control of blood pressure prevents macrovascular and microvascular complications, and comparing the advantages and disadvantages in tight control with either captopril-or atenololtreated type 2 diabetic patients with a randomized controlled design. At the end of the study, the difference in blood pressures between the tight control and less tight control groups were 10/5 mmHg (144/82 vs. 154/87 mmHg, p<0.0001). Tight control of blood pressure is effectivein reducing risks in diabetes-related end points, deaths related to diabetes, stroke, and microvascular end points, by 24%, 32%, 44%, and 37%, respectively. On the other hand, the mean blood pressures in the tight control groups treated with captopril and atenolol were 144/83 mmHg and 143/81 mmHg, respectively (p > 0.05); and the main outcomes and side effect of hypoglycemia did not differ significantly between these two groups. Taken together, we concluded from these reports that: 1) diabetes mellitus is a major cardiovascular risk factor; 2) hypertension in diabetic patients should be controlled tightly; and 3) blood pressure control itself is much more important than the treatment used. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。