抗高血压药物引起的糖尿病不容忽视(英文)

1、DRUG INDUCED DIABETES DURING ANTIHYPERTENSIVE THERAPY IS IMPORTANT - BUTCHINESE SOCIETY OF HYPERTENSIONMICHAEL ALDERMANMAY 22, 20081精选版Prevalence of diabetes among Chinese adults aged 3564 years in the 1994 Chinese National Survey (10) and 20002001 InterASIA StudyGu et al Diabetologia. 2003;46:1190.

2、2精选版Percent of deathsGeiss LS, et al. In: Diabetes in America. National Institutes of Health;1995.65% of Mortality in people with Diabetes is CVD Ischemic heart diseaseOther heart diseaseDiabetesMalignant neoplasmsCerebrovascular diseasePneumonia/influenzaAll other3精选版CV mortality rate per10,000 per

3、son-yearsSystolic BP and CV Death in MRFITNondiabetic (n=342,815)Diabetic (n=5,163)120120-139Systolic BP (mmHg)140-159160-179180-199200Stamler J, et al. Diabetes Care. 1993;16:434-444.BP= blood pressure CV=cardiovascular MRFIT=Multiple Risk Factor Intervention Trial4精选版Annual Incidence of Diabetes i

4、n Hypertensive PatientsSHEP untreated controls = 2.7%SHEP treated = 3.9%Lancet. 2006, 368;1673-1679, Am J Cardiol. 2005;95:29,Hypertension.2007;50:467, JAMA 2002;288:2981-2997 5精选版NHANES 18 year Follow-upNOD in US Women by Baseline BPConen, D. et al. Eur Heart J 2007 28:2937-2943140mmHg6精选版.Conen, D

5、. et al. Eur Heart J 2007 28:2937-2943Age-adjusted incidence rates (A) and HRs (B) of NOD according to blood pressure category, stratified by baseline body mass index7精选版THE ISSUESCONSEQUENCES OF NODCVD AND non-CVDHOW DO ANTIHYPERTENSIVE DRUGS EFFECT INCIDENCE OF NOD AND CVD ONSEQUENCES?HOW SHOULD N

6、OD EFFECT MANAGEMENT FOR CVD PROTECTION?8精选版Non-CVD Consequences of NODImpaired BP controlBehavioral and PsychologicalMicrovascular consequences (?) Medical care demandsTreatment changes9精选版CVD ConsequencesShort and Long termAntihypertensive Drug Related10精选版.Whelton, P. K. et al. Arch Intern Med 20

7、05;165:1401-1409.ALLHATIncidence of Coronary heart disease by treatment group according to baseline diabetes mellitus, impaired fasting glucose level, or normoglycemia11精选版Barzilay, J. I. et al ALLHAT. Arch Intern Med 2006;166:2191-2201.HRs of a 10-mg/dL (0.56-mm) FBG at 2 years for subsequent CVD a

8、nd Renal Disease12精选版 Effect of ACEIs and ARBs on CVD MortalitySource# studies#subjectsOR (95% CI)All11109,0520.96(0.91-1.01)ACEI674,6260.93(0.81-1.06)ARB534,4260.93 (0.81-1.06)HTN786,4140.99 (0.93-1.06)Gillespie, et al. Diabetes Care 28:2261-2266, 200513精选版Age-genderadjusted in treatment CVD and no

9、n-CVD by baseline FBG among hypertensive patients.Alderman, Hypertension. 1999;33:1130-113414精选版Myocardial infarction (fatal and nonfatal) in hypertensive patients according to DM statusAksnes, T. A. et al. Hypertension 2007;5015精选版Diabetes Incidence - 4 Years(follow-up FBS 126 mg/dL for those 126 m

10、g/dL at baseline)* p.05 compared to chlorthalidoneALLHATJAMA 2002;288:2981-299716精选版Ramipril v. Placebo in high risk patients with IGT at baselineDream. NEJM;355:1551-1562,200617精选版Ramipril v. Placebo CVD & non-CVD OutcomesDream. NEJM;355:1551-1562,200618精选版.Whelton, P. K. et al. Arch Intern Med 200

11、5;165:1401-1409.ALLHAT: RR (and 6-year rates per 100 for nondiuretic compared with diuretic for diabetes mellitus (A), impaired fasing glucose level (B), and normoglycemia (C) at baseline, for CHD, all-cause mortality, combined CHD, stroke, HF, all CVD, and ESRD19精选版CV death (%)PLACEBOACTIVE* = p 0.

12、05 vs no diabetesSHEP - 14 YEAR FOLLOW-UP20精选版CONCLUSIONS FROM SHEP +Chlorthalidone Rx of hypertension improves long-term outcomes.The diabetes related to chlorthalidone therapy has better prognosis than diabetes at baseline.The benefit of chlorthalidone-based therapy on long-term total and CV morta

13、lity is most pronounced in hypertensive patients with diabetes.21精选版 Reduction in major CVD among 6,000 DM in HPS associated with 38/89 LDL/CHOL by StatinMazzone, T.The American Journal of Medicine 120;2007, S26-S32 22精选版Incidence of MI and Microvascular Endpoints by Mean SBP and HbA1c in UKPDSAdjus

14、ted incidence per 1000 person-years (%)Updated mean HbA1c concentration (%)Mean SBP (mmHg)Adjusted incidence per 1000 person-years (%)567891011110120130140150160170Myocardial infarctionMicrovascular endpointsMicrovascular endpointsMyocardial infarctionAdler AI, et al. BMJ. 2000;321:412-419.Stratton

15、IM, et al. BMJ. 2000;321:405-412.MI=myocardial infarction SBP=systolic blood pressure23精选版UNCERTAINTY CONTINUESACCORD AND ADVANCEACCORD - Mortality greater with HbAlc 6.4 v. 7.0-7.9%ADVANCE - No evidence of mortality with HbAlc 6.4 v. 7,5%24精选版Major CV Event Rate In HOTHOTLancet 1998;351:1755 90 85

16、80 90 85 80 85.283.281.1 DBP achievedp = 0.00551% riskreductionGoal Diastolic mmHgDiabetic populationNon-Diabetic subjects25精选版CONCLUSIONSDM serious whenever it occursMore common in hypertensive Rx Particularly with diureticsNOD has consequences Non-CVD in short termCVD long termNeither fear of, nor NOD, requires