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Hypertension and diabetes often exist, which has a synergistic effect on the harm of cardiovascular and cerebrovascular. Hypertension is an important risk factor for diabetic cardiovascular and microvascular complications. Once diabetes is combined with hypertension, it will significantly increase the risk of cardiovascular and cerebrovascular events. So, what is the antihypertensive target value of hypertension with diabetes? What do you need to pay attention to in terms of medication? At the 30th Great Wall Cardiology Conference (GW-ICC), Yantong conducted an exclusive interview with Professor Xie Liangdi, the first hospital affiliated to Fujian Medical University on related issues.
Popularity and harm of hypertension patients with diabetes
For a long time, the prevalence of hypertension has generally increased. The latest survey (2015) showed that the prevalence of hypertension was close to 30%. In fact, as a risk factor for cardiovascular and cerebrovascular disease, hypertension often does not exist alone. Related studies have shown that more than 80%of patients with hypertension in China have more than two risk factors, and about 30%of them will combine diabetes or sugar metabolism abnormalities. Correspondingly, more than 50%of patients with diabetes will be combined with hypertension.
As early as Framingham studies, the more risk factors in the merger of hypertension patients, the higher the risk of cardiovascular disease. Diabetes itself will bring damage to cardiovascular and cerebrovascular, and its damage to blood vessels is similar to high blood pressure. By causing damage to vascular endothelials, it will cause damage to target organs and even functional failure. The main organs of diabetes include heart, brain, kidney, bottom, and peripheral arteries. When diabetes is combined with high blood pressure, the degree of damage to the target organs will increase. If you increase the damage to the eyes and kidneys by 2 times, it will increase by 7.2 times.
In the 2018 version of “Guidelines for Prevention and Control of Hypertension”, diabetes in the cardiovascular risk assessment and layered content parts are more detailed. Cardiovascular risk of diabetes without complications and diabetes with complications are different. Essence Therefore, as long as high blood pressure is combined with diabetes, the risk of cardiovascular and cerebrovascular diseases will increase significantly.
Hypertension combined with diabetes patients with antihypertensive target value
The treatment of patients with hypertension combined with diabetes mainly includes three aspects: one is to control blood pressure; the other is to control blood sugar; the third is to control the risk factors that exist at the same time, including smoking, obesity, hyperlipidemia, etc.
When it comes to antihypertensive target values, we must first know the purpose of antihypertensive treatment. The purpose of hypertension patients with pressure pressure treatment is to effectively prevent or delay complications such as stroke, myocardial infarction, heart failure, and renal dysfunction by reducing blood pressure. Severe hypertension occurs.
Regarding the antihypertensive target value of patients with hypertension with diabetes, the currently recognized is <130/80 mmHg, and patients with elderly and coronary heart disease are <140/90 mmHg. China Hypertension Prevention Guide, the Guide to the Diabetes Branch of the Chinese Medical Association, the US Hypertension Guide, the US ADA Guide and the European ESC Guide to set the anti -pressure -lowering target value slightly different. In the past ten years, it has experienced multiple blood pressure target settings Change.
The change of blood pressure target value has a lot to do with the results of clinical research. It can be roughly divided into three stages:
The first stage: UKPDS research shows that among patients with type 2 diabetes, the relationship between blood pressure and cardiovascular events is that the lower the blood pressure, the less cardiovascular events, and the lowest cardiovascular incident rate of 120 mmHg. In the same year, HOT studies have also found that the cardiovascular incident of the 90 mmHg and 85 mmHg group at the current 90 mmHg and 85 mmHg group has declined significantly, and the stroke decline is particularly obvious, and there is the same trend in the type 2 diabetes Asian group.
The second stage: The analysis of the results of the results of account-BP and Invesr’s research made people question the systolic blood pressure in the antihypertensive targets of type 2 diabetes in each guide <130 mmHg. Adjust to 140 mmHg. However, strengthening antihypertensive can reduce diabetic nephropathy, which has been confirmed in many large clinical studies.
Third stage: Recent SBP strengthening antihypertensive intervention test Sprint research shows that for people with high cardiovascular and risk factors, the systolic blood pressure will be less than 120 mmHg, which can significantly reduce cardiovascular events and risk of death. Show the same trend. However, the method of measuring blood pressure is the measurement of the automatic blood pressure measuring instrument of the outpatient clinic, which is not the same as other tests, and there is still a contradiction between the post -analysis and registration research of the research. The test results are yet to be questioned.
In general, according to the current results of clinical research and guidelines, the antihypertensive target of high blood pressure combined with diabetes is <130/80 mmHg. However, the recommendation of this target value lacks powerful clinical trial support. In the future, one or more of the random, double -blind, and control clinical trials that are suitable for diabetic patients to determine specific antihypertensive targets.
Medication for patients with hypertension with diabetes
<!-2664: Cardiovascular terminal pageUse drug updates to recommend drugs.Professor Xie Liangdi said that for ordinary patients with hypertension, vascular tensioner converting enzyme inhibitors (ACEI), vascular tension II receptor blockers (ARB), calcium ion antagonist (CCB), diuretics and β -sufferingBody blockers, etc. can be recommended as antihypertensive drugs.
For patients with high blood pressure combined with diabetes, according to the existing clinical data and scientific research results, it is also recommended to use ACEI and ARB antihypertensive drugs that have protected renal function.In addition, for such patients, the guide often recommends joint medication, such as ACEI or ARB -type antihypertensive drugs combined with calcium ion antagonist, which is the “A+C” scheme mentioned in the guide, which will bring greater gains to patients to get greater gains.beneficial.