Combined intensive blood pressure and glycemic control does not produce an additive benefit on microvascular outcomes in type 2 diabetic patients.
Combined intensive blood pressure and glycemic control does not produce an additive benefit on microvascular outcomes in type 2 diabetic patients.
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DOI：
10.1038/ki.2011.415
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发表时间：
2012-03
影响因子：
19.6
通讯作者：
ACCORD Study Group
中科院分区：
文献类型：
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作者：
Ismail-Beigi F;Craven TE;O'Connor PJ;Karl D;Calles-Escandon J;Hramiak I;Genuth S;Cushman WC;Gerstein HC;Probstfield JL;Katz L;Schubart U;ACCORD Study Group
降低血压或降血糖可以减少2型糖尿病的一些微血管并发症，我们在这里研究了它们的联合作用。总共有4733名患有2型糖尿病和高血压的老年人被随机分配到强化（收缩压低于120 mmHg）或标准（收缩压低于140 mmHg）血压控制组，并分别接受强化（HbA 1c低于0.060）或标准（HbA 1c 0.070-0.079）血糖控制组。预先规定的微血管结局是肾衰竭和视网膜病变的复合结局和9个单一结局。使用比例风险回归模型，由于多次检验，未校正I型错误。在平均4.7年的随访中，主要结局发生在11.4%的强化和10.9%的标准血压患者（风险比1.08），11.1%的强化和11.2%的标准血压控制患者。强化血压控制仅降低了微量白蛋白尿的发生率（风险比0.84），强化血糖控制降低了大量白蛋白尿和其他一些微血管结局的发生率。血压和血糖控制之间没有相互作用，两种治疗都不能预防肾衰竭。因此，在患有2型糖尿病和高血压的老年患者中，强化血压控制仅改善了10个预先指定的微血管结局中的1个。没有一个结果是显着减少的同时强化治疗的血压，这表明缺乏一个额外的有益效果，从联合治疗。
A reduction of either blood pressure or glycemia decreases some microvascular complications of type 2 diabetes, and we studied here their combined effects. In total, 4733 older adults with established type 2 diabetes and hypertension were randomly assigned to intensive (systolic blood pressure less than 120mmHg) or standard (systolic blood pressure less than 140mmHg) blood pressure control, and separately to intensive (HbA1c less than 0.060) or standard (HbA1c 0.070–0.079) glycemic control. Prespecified microvascular outcomes were a composite of renal failure and retinopathy and nine single outcomes. Proportional hazard regression models were used without correction for type I error due to multiple tests. During a mean follow-up of 4.7 years, the primary outcome occurred in 11.4% of intensive and 10.9% of standard blood pressure patients (hazard ratio 1.08), and in 11.1% of intensive and 11.2% of standard glycemia control patients. Intensive blood pressure control only reduced the incidence of microalbuminuria (hazard ratio 0.84), and intensive glycemic control reduced the incidence of macroalbuminuria and a few other microvascular outcomes. There was no interaction between blood pressure and glycemic control, and neither treatment prevented renal failure. Thus, in older patients with established type 2 diabetes and hypertension, intensive blood pressure control improved only 1 of 10 prespecified microvascular outcomes. None of the outcomes were significantly reduced by simultaneous intensive treatment of glycemia and blood pressure, signifying the lack of an additional beneficial effect from combined treatment.