Diabetes and hypertension: the bad companions
Diabetes and hypertension: the bad companions
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DOI：
10.1016/s0140-6736(12)60987-8
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发表时间：
2012-08-11
期刊：
影响因子：
168.9
通讯作者：
Cushman, William C.
中科院分区：
文献类型：
--
作者：
Ferrannini, Ele;Cushman, William C.
2型糖尿病患者中有超过三分之二的人患有高血压，其发展与高血压的发展一致。许多病理生理机制是这种关联的基础。在这些机制中，一氧化氮途径中的胰岛素抵抗;高胰岛素血症对交感神经驱动、平滑肌生长和钠液潴留的刺激作用;以及高胰岛素血症对肾素-血管紧张素-醛固酮系统的兴奋作用似乎是合理的。在糖尿病患者中，高血压会增加心血管疾病的风险。根据临床试验证据，血压低于140/85 mm Hg是2型糖尿病患者的合理治疗目标。糖尿病控制患者与非糖尿病但患有高血压的患者具有相似的心血管风险。对于大多数糖尿病患者，肾素-血管紧张素系统阻滞剂联合噻嗪类利尿剂可能是最佳的初始降压方案。一般而言，抗高血压药物对心血管结局的积极影响超过抗高血压药物对糖代谢的负面影响。
High blood pressure is reported in over two-thirds of patients with type 2 diabetes, and its development coincides with the development of hyperglycaemia. Many pathophysiological mechanisms underlie this association. Of these mechanisms, insulin resistance in the nitric-oxide pathway; the stimulatory effect of hyperinsulinaemia on sympathetic drive, smooth muscle growth, and sodium-fluid retention; and the excitatory effect of hyperglycaemia on the renin-angiotensin-aldosterone system seem to be plausible. In patients with diabetes, hypertension confers an enhanced risk of cardiovascular disease. A blood pressure of lower than 140/85 mm Hg is a reasonable therapeutic goal in patients with type 2 diabetes according to clinical trial evidence. People with controlled diabetes have a similar cardiovascular risk to patients without diabetes but with hypertension. A renin-angiotensin system blocker combined with a thiazide-type diuretic might be the best initial antihypertensive regimen for most people with diabetes. In general, the positive effects of antihypertensive drugs on cardiovascular outcomes outweigh the negative effects of antihypertensive drugs on glucose metabolism.