2005年美國糖尿病學會針對糖尿病合併高血壓之標準治療建議

全文

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427

2005

1 2 3

1

2

3

( 140 mmHg / 90 mmHg )

130 mmHg 80 mmHg

11 5 / 7 5

mmHg 130/80 mmHg

(Angiotensin-converting enzyme in- hibitors ACEI) Angiotension receptor blockers ARB

-blockers ( Diuretics ) Calcium channel blockers CCB 160/100 mmHg

( Diabetes mellitus, DM ) ( Hypertension, HTN )

( Cardiovascular disease, CVD )

(2)

( 140 mmHg /

90 mmHg )

20~60%

1

1

30% 1

2-3

2 20-60%

1

2 1.5

1

4 0

19% 38%

4 0

3 0 . 6 %

4

140/90 mmHg 5 mmHg 20-30%

5

130 mmHg 80

mmHg

6-9

115/75 mmHg

6,10,11

2000

130/80 mmHg

12

JNC 130/80 mmHg

1 g

125/75 mmHg

4600 mg 2300 mg 5 / 2 - 3 m m H g

6

1

1 mmHg

13

( A n g i o t e n s i n - c o n v e r t i n g e n z y m e i n h i b i t o r s A C E I )

Angiotension receptor blockers ARB -blockers ( Diuretics )

Calcium channel blockers CCB

dihydropyridine calcium channel blockers ( D- CCB )

14,15

DCCB

16

2 2 , 5 7 6

Verapamil SR-Trandolapril (IN-

VEST) verapamil (non- D-

CCB )

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17

18-19

20

ALLHAT ( antihypertensive and lipid-lowering treatment to prevent heart attack trial )

chlorthalidone am- lodipine lisinopril

thiazide

21

SHEP ( systolic hy- pertension in the elderly program )

60 thi-

azide

34% (p< 0.05)

22

23 24

130/85 mmHg

X

25

160/100 mmHg

6

( )

110-129 mmHg 65-79 mmHg

methyldopa labatolol diltiazem clonidine prazosin

26

ADA

26

A-Level evidence

B-Level evidence

C-Level evidence

Expert consensus

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130/80 mmHg (C )

1. 130 mmHg

(C )

2. 80 mmHg

(B )

1. 140 mmHg

90 mmHg (A ) 2.

( ) (B )

3. 130-139/80-89 mmHg

(E ) 4.

(

) (A ) 5.

thiazide (E

) 6.

(E ) 7.

(1) 1

(A ) ( 2 ) 2

(A )

(3) 2

(A ) ( 4 )

1 1 0 - 1 2 9

mmHg 65-79 mmHg

(E ) ( 5 )

(E ) ( 6 )

(E ) ( 7 )

(E )

1.Hypertension in Diabetic Study (HDS). Prevalence of hyper- tension in newly presenting type 2 diabetic patients and the as- sociation with risk factors for cardiovascular and diabetic com- plications. J Hyperten 1993; 11: 309-17.

2.Nishimura R, LaPorte RE, Dorman JS, Tajima N, Becker D, Orchard TJ. Mortality trends in type 1 diabetes: the Allegheny County (Pennsylvania) Registry 1965-1999. Diabetes Care 2001; 24: 823-7.

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of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289 : 2560-72.

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Preserving renal function in adults with hypertension and dia- betes: a consensus approach. Am J Kidney Dis 2000; 36: 646- 61.

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645-52.

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138: 542-49.

17.Pepine CJ, Handberg EM, Cooper-DeHoff RM, et al. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease: the International Verapamil-Trandolapril study (INVEST): a ran- domized controlled trial. JAMA 2003; 290: 2805-16.

18.Heart Outcomes Prevention Evaluation Study Investigators.

Effects of ramipril on cardiovascular and microvascular out- comes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000; 355: 253-59.

19.PROGRESS group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with

previous stroke or transient ischaemic attack. Lancet 2001; 358:

1033-41.

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1004-10.

21.ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting en- zyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981-97.

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134-47.

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2005 ADA Standard Recommendations for Treatment of Diabetes with Hypertension

Lyh-Jyh Hao, Chwen-Yi Yang

1

, Chang-Sheng Ku

2

, Kuo-Liang Chai

3

Hypertension (HTN) (BP 140/90 mmHg) is a common comorbidity of diabetes, affecting the majority of people with diabetes, depending on type of diabetes, age, obesity, and ethnicity. HTN is also a major risk factor for CVD and microvascular complications such as retinopathy and nephropathy. Randomized clinical trials have demonstrated the benefit (reduction of CHD events, stroke, and nephropathy) of lowering BP to <130 mmHg sys- tolic and <80 mmHg diastolic in individuals with diabetes. Epidemiologic analyses show that BP >115/75 mmHg is associated with increased cardiovascular event rates and mortality in individuals with diabetes. Therefore, a target BP goal of <130/80 mmHg is reasonable. Nonpharmacological strategies include reducing sodium intake and body weight; increasing consumption of fruits, vegetables, and low-fat dairy products; avoiding excessive al- cohol consumption; and increasing activity levels have been shown to be effective in reducing BP in nondiabe- tic individuals and may also positively affect glycemia and lipid control. Lowering of BP with regimens based on antihypertensive drugs, including ACE inhibitors, angiotensin receptor blockers (ARBs), -blockers, diuretics, and calcium channel blockers, has been shown to be effective in lowering cardiovascular events. Systolic BP 160 mmHg or diastolic BP 100 mmHg, however, mandates that immediate pharmacological therapy be initiat- ed and should be seen as often as needed . In these patients, other cardiovascular risk factors, including obesi- ty, hyperlipidemia, smoking, presence of microalbuminuria, and glycemic control, should be carefully assessed and treated. Many patients will require three or more drugs to reach target goals. ( J Intern Med Taiwan 2005; 16:

107-112 )

Division of Endocrinology and Metabolism, Yung Kang Veterans Hospital

1

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi-Mei Foundation Hospital, Tainan, Taiwan

2

Division of Cardiology, Yung Kang Veterans Hospital

3

Department of Internal Medicine, Yung Kang Veterans Hospital

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