Hypertension resistant to antihypertensive agents commonly occurs with the progression of diabetic nephropathy in Japanese patients with type 2 diabetes mellitus: a prospective observational study
Hypertension resistant to antihypertensive agents commonly occurs with the progression of diabetic nephropathy in Japanese patients with type 2 diabetes mellitus: a prospective observational study
复制标题
DOI：
10.1186/1471-2369-13-48
复制
发表时间：
2012-06-27
期刊：
影响因子：
2.3
通讯作者：
Tsugami, Emiko
中科院分区：
文献类型：
--
作者：
Ito, Hiroyuki;Mifune, Mizuo;Tsugami, Emiko
背景：我们通过一项前瞻性观察研究，调查了 1) 2 型糖尿病患者的高血压发生率，该患者按照《肾脏病：改善全球结果》(KDIGO) 报告的慢性肾脏病 (CKD) 新分类进行分级，2) 实现治疗目标所需的抗高血压药物数量。方法：招募了 2018 名 2 型糖尿病患者参与本研究。根据 eGFR 和尿白蛋白排泄水平对 CKD 分期进行分类。 结果：1420 名患者（70%）发现高血压，基线时血压 < 130/80 mmHg 的受试者比例为 31%。尽管平均血压约为130/75 mmHg，但观察期间血压<130/80 mmHg的患者比例仅限于41-50%。终点时治疗所需的抗高血压药物数量 (2.0 +/- 1.3) 显着高于基线 (1.6 +/- 1.2)。此外，在基线和观察终点，它都随着 CKD 阶段的进展而增加。然而，在CKD晚期组中，未达到血压目标的受试者频率有所增加。结论：对降压药产生抵抗的高血压在2型糖尿病患者中很常见，并且随着CKD的进展而增加。尽管使用抗高血压药物的强力联合治疗被认为是严格控制血压所必需的，但这对于根据 eGFR 和尿白蛋白排泄水平分级的晚期个体来说变得困难。
Background: We investigated 1) the frequency of hypertension in patients with type 2 diabetes graded by the new classification of chronic kidney disease (CKD) reported by the Kidney Disease: Improving Global Outcomes (KDIGO) and 2) the number of antihypertensive agents needed to achieve treatment goals using a prospective observational study.Methods: A population of 2018 patients with type 2 diabetes mellitus was recruited for the study. The CKD stage was classified according to the eGFR and the urinary albumin excretion levels.Results: Hypertension was found in 1420 (70%) of the patients, and the proportion of subjects showing a blood pressure < 130/80 mmHg was 31% at the baseline. Although the mean blood pressure was approximately 130/75 mmHg, the rate of patients with a blood pressure of < 130/80 mmHg became limited to 41-50% during the observation period. The number of antihypertensive agents required for treatment was significantly higher at the endpoint (2.0 +/- 1.3) than at the baseline (1.6 +/- 1.2). Furthermore, it increased with the progression of the CKD stage at both the baseline and the endpoint of the observation. However, the frequency of subjects who did not achieve the blood pressure target was found to increase in the group demonstrating the later stage of CKD.Conclusions: Hypertension resistant to antihypertensive agents was common in the patients with type 2 diabetes mellitus and increased with the progression of CKD. Although powerful combination therapy using antihypertensive agents is considered necessary for the strict control of blood pressure, this became difficult in individuals who were in advanced stages as graded based on the eGFR and the urinary albumin excretion levels.