Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension
Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension
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DOI：
10.1056/nejm199903043400902
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发表时间：
1999-03-04
影响因子：
158.5
通讯作者：
Hübner, GE
中科院分区：
文献类型：
--
作者：
Tuomilehto, J;Rastenyte, D;Hübner, GE
背景最近的报道表明，钙通道阻滞剂可能对糖尿病和高血压患者有害。我们以前报道过钙通道阻滞剂尼群地平降压治疗可降低心血管事件的风险。在这项事后分析中，我们比较了尼群地平治疗糖尿病和非糖尿病患者的结果。（年龄、大于或等于60岁）收缩压160 - 219 mm Hg，舒张压低于95 mm Hg的患者随机接受活性药物治疗或安慰剂治疗。积极治疗包括尼群地平（每天10至40毫克），可能添加或替代依那普利（每天5至20毫克）或氢氯噻嗪（每天12.5至25毫克）或两者，滴定以降低收缩压至少20毫米汞柱并低于150毫米汞柱。在对照组中，匹配的安慰剂片剂管理similarly.Results在随机化，492例（10.5%）有糖尿病。经过两年的中位随访，糖尿病患者中安慰剂组和活性治疗组的收缩压和舒张压分别相差8.6和3.9 mm Hg。在4203例无糖尿病的患者中，两组的收缩压和舒张压分别相差10.3和4.5 mm Hg。在调整了可能的混杂因素后，发现积极治疗使总死亡率降低了55（从每1000名患者中45.1人死亡到每1000名患者中26.4人死亡），心血管疾病死亡率降低76%，所有心血管事件合计降低69%，致命性和非致命性中风降低73%，而糖尿病患者组的所有心脏事件合计为63%。在非糖尿病患者中，积极治疗使所有心血管事件减少了26%，致命性和非致命性中风减少了38%。在接受积极治疗的患者组中，糖尿病患者的总死亡率、心血管疾病死亡率和所有心血管事件的降低均显著大于非糖尿病患者（P=0.04，P=0.02和P=0.01，分别）。结论以尼群地平为基础的降压治疗对老年糖尿病合并单纯收缩期高血压患者特别有益。因此，我们的研究结果不支持使用长效钙通道阻滞剂可能对糖尿病患者有害的假设。（N Engl J Med 1999;340：677-84）（C）1999，马萨诸塞州医学会。
Background Recent reports suggest that calcium-channel blockers may be harmful in patients with diabetes and hypertension. We previously reported that antihypertensive treatment with the calcium-channel blocker nitrendipine reduced the risk of cardiovascular events. In this post hoc analysis, we compared the outcome of treatment with nitrendipine in diabetic and nondiabetic patients.Methods After stratification according to center, sex, and presence or absence of previous cardiovascular complications, 4695 patients (age, greater than or equal to 60 years) with systolic blood pressure of 160 to 219 mm Hg and diastolic pressure below 95 mm Hg were randomly assigned to receive active treatment or placebo. Active treatment consisted of nitrendipine (10 to 40 mg per day) with the possible addition or substitution of enalapril (5 to 20 mg per day) or hydrochlorothiazide (12.5 to 25 mg per day) or both, titrated to reduce the systolic blood pressure by at least 20 mm Hg and to less than 150 mm Hg. In the control group, matching placebo tablets were administered similarly.Results At randomization, 492 patients (10.5 percent) had diabetes. After a median follow-up of two years, the systolic and diastolic blood pressures in the placebo and active-treatment groups differed by 8.6 and 3.9 mm Hg, respectively, among the diabetic patients. Among the 4203 patients without diabetes, systolic and diastolic pressures differed by 10.3 and 4.5 mm Hg, respectively, in the two groups. After adjustment for possible confounders, active treatment was found to have reduced overall mortality by 55 percent (from 45.1 deaths per 1000 patients to 26.4 deaths per 1000 patients), mortality from cardiovascular disease by 76 percent, all cardiovascular events combined by 69 percent, fatal and nonfatal strokes by 73 percent, and all cardiac events combined by 63 percent in the group of patients with diabetes. Among the nondiabetic patients, active treatment decreased all cardiovascular events combined by 26 percent and fatal and nonfatal strokes by 38 percent. In the group of patients receiving active treatment, reductions in overall mortality, mortality from cardiovascular disease, and all cardiovascular events were significantly larger among the diabetic patients than among the nondiabetic patients (P=0.04, P=0.02, and P=0.01, respectively).Conclusions Nitrendipine-based antihypertensive therapy is particularly beneficial in older patients with diabetes and isolated systolic hypertension. Thus, our findings do not support the hypothesis that the use of long-acting calcium-channel blockers may be harmful in diabetic patients. (N Engl J Med 1999;340:677-84) (C) 1999, Massachusetts Medical Society.