Effects of valsartan compared to amlodipine on preventing type 2 diabetes in high-risk hypertensive patients: the VALUE trial
Effects of valsartan compared to amlodipine on preventing type 2 diabetes in high-risk hypertensive patients: the VALUE trial
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DOI：
10.1097/01.hjh.0000234122.55895.5b
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发表时间：
2006-07-01
影响因子：
4.9
通讯作者：
Zanchetti, Alberto
中科院分区：
文献类型：
--
作者：
Kjeldsen, Sverre E.;Julius, Stevo;Zanchetti, Alberto
背景2型糖尿病正在成为一个主要的健康问题，在心血管疾病高危人群中，它往往与高血压聚集在一起。目的首次验证血管紧张素受体阻滞剂（ARB）缬沙坦与代谢中性钙通道拮抗剂（CCA）氨氯地平相比对高危高血压患者预防新发2型糖尿病的作用。设计VALUE试验中预先指定的分析。随访平均4.2年。对于不同的糖尿病定义，以95%可信区间（CI）的比值比（OR）计算发生新糖尿病的风险。9995例高危非糖尿病性高血压患者。缬沙坦或氨氯地平加或不加附加药物[氢氯噻嗪（HCTZ）和其他附加药物，不包括其他arb、血管紧张素转换酶（ACE）抑制剂，cca]。新的糖尿病定义为不良事件，新的降糖药物和/或空腹血糖> 7.0 mmol/l。结果缬沙坦组有580例（11.5%）新发糖尿病，氨氯地平组有718例（14.5%）新发糖尿病（OR 0.77, 95% CI 0.69-0.87, P < 0.0001）。采用更严格的标准（无不良事件报告），缬沙坦组495例（9.8%）患者和氨氯地平组586例（11.8%）患者新发糖尿病（OR 0.82, 95% CI 0.72-0.93, P = 0.0015）。结论与氨氯地平相比，缬沙坦可降低高血压高危患者发生糖尿病的风险。[J]中国科学：自然科学与工程学报（英文版），2006。
Context Type 2 diabetes is emerging as a major health problem, which tends to cluster with hypertension in individuals at high risk of cardiovascular disease.Objective To test for the first time the hypothesis that treatment of hypertensive patients at high cardiovascular risk with the angiotensin-receptor blocker (ARB) valsartan prevents new-onset type 2 diabetes compared with the metabolically neutral calcium-channel antagonist (CCA) amlodipine.Design Pre-specified analysis in the VALUE trial. Follow-up averaged 4.2 years. The risk of developing new diabetes was calculated as an odds ratio (OR) with 95% confidence intervals (CI) for different definitions of diabetes.Patients A sample of 9995 high-risk, non-diabetic hypertensive patients.Interventions Valsartan or amlodipine with or without add-on medication [hydrochlorothiazide (HCTZ) and other add-ons, excluding other ARBs, angiotensin-converting enzyme (ACE) inhibitors, CCAs].Main outcome measure New diabetes defined as an adverse event, new blood-glucose-lowering drugs and/or fasting glucose > 7.0 mmol/l.Results New diabetes was reported in 580 (11.5%) patients on valsartan and in 718 (14.5%) patients on amlodipine (OR 0.77, 95% CI 0.69-0.87, P < 0.0001). Using stricter criteria (without adverse event reports) new diabetes was detected in 495 (9.8%) patients on valsartan and in 586 (11.8%) on amlodipine (OR 0.82, 95% CI 0.72-0.93, P = 0.0015).Conclusion Compared with amlodipine, valsartan reduces the risk of developing diabetes mellitus in high-risk hypertensive patients. J Hypertens 24:1405-1412 (c) 2006 Lippincott Williams & Wilkins.