IMPACT OF BLOOD-PRESSURE AND ANTIHYPERTENSIVE TREATMENT ON INCIPIENT AND OVERT NEPHROPATHY, RETINOPATHY, AND ENDOTHELIAL PERMEABILITY IN DIABETES-MELLITUS
IMPACT OF BLOOD-PRESSURE AND ANTIHYPERTENSIVE TREATMENT ON INCIPIENT AND OVERT NEPHROPATHY, RETINOPATHY, AND ENDOTHELIAL PERMEABILITY IN DIABETES-MELLITUS
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DOI：
10.2337/diacare.14.3.260
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发表时间：
1991-03-01
期刊：
影响因子：
16.2
通讯作者：
PARVING, HH
中科院分区：
文献类型：
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作者：
PARVING, HH
糖尿病肾病是胰岛素依赖型糖尿病（IDDM）患者发病率和死亡率增加的主要原因。血压升高会加速血压升高，而使用 β 受体阻滞剂和/或血管紧张素转换酶 (ACE) 抑制剂有效降低血压可延缓肾病的进展并减少蛋白尿。之前所有涉及糖尿病肾病自然史的报告均表明，肾病发病 10 年后，累积死亡率在 50% 至 77% 之间。有效的抗高血压治疗可将肾病发病后 10 年的累积死亡率降低至 15-20%。最近的随机对照研究表明，ACE 抑制可能会延缓甚至预防血压正常且持续微量白蛋白尿的 IDDM 患者发生糖尿病肾病。一些横断面和前瞻性研究表明血压升高与糖尿病视网膜病变的发生和进展之间存在关联。此外，颈动脉供血不足或单侧或双侧视网膜血流量（压力）减少的其他原因可减少糖尿病视网膜病变的发展。糖尿病视网膜病变的特点是荧光素通过血视网膜屏障异常渗漏，这种异常现象可以在抗高血压治疗期间逆转。有充分证据表明，血压升高、代谢控制不良和糖尿病微血管病变独立地增强了糖尿病患者血浆蛋白的内皮渗漏。毛细血管高压、血浆蛋白外渗增加与糖尿病微血管病的发生和进展之间存在联系。血压降低可减少血浆蛋白的外渗。上述结果有力地支持了早期有效治疗糖尿病动脉血压升高的情况。
Diabetic nephropathy is the main cause of the increased morbidity and mortality in insulin-dependent diabetes mellitus (IDDM) patients. Elevated blood pressure accelerates and effective blood pressure reduction with beta-blockers and/or angiotensin-converting enzyme (ACE) inhibitors delays the progression of nephropathy and reduces albuminuria. All previous reports dealing with the natural history of diabetic nephropathy demonstrated a cumulative death rate between 50 and 77% 10 yr after onset of nephropathy. Effective antihypertensive treatment reduced the cumulative death rate to 15-20% 10 yr after onset of nephropathy. Recent randomized control studies indicate that ACE inhibition may delay and even prevent the development of diabetic nephropathy in normotensive IDDM patients with persistent microalbuminuria. Several cross-sectional and prospective studies suggest an association between elevated blood pressure and the development and progression of diabetic retinopathy. Furthermore, carotic insufficiency or other causes of unilaterally or bilaterally reduced retinal blood flow (pressure) diminish the development of diabetic retinopathy. Diabetic retinopathy is characterized by abnormal leakage of fluorescein through the blood-retinal barrier, an abnormality that can be reversed during antihypertensive treatment. It is well documented that elevated blood pressure, poor metabolic control, and diabetic microangiopathy independently enhance the endothelial leakage of plasma proteins in diabetes mellitus. A link between capillary hypertension, increased extravasation of plasma proteins, and the development and progression of diabetic microangiopathy has been suggested. Blood pressure reduction diminishes the extravasation of plasma proteins. The above results strongly support the case for early and effective treatment of arterial blood pressure elevation in diabetes.