强化降压治疗对2型糖尿病患者病死率及心血管和肾脏预后影响的荟萃分析

Effects of intensive blood pressure lowering treatment on mortality and cardiovascular and renal prognoses in patients with type 2 diabetes mellitus: a meta-analysis

目的探讨强化降压治疗对2型糖尿病患者病死率及心血管和肾脏预后的影响,并阐明其疗效。方法通过搜索PubMed、EMBASE、科学引文索引和Cochrane图书馆数据库,以确定符合研究纳入标准的随机对照试验(RCT)。两名调查人员独立提取并汇总纳入试验的相关数据,并采用随机效应模型计算所有效应指标的估计值。结果纳入16项随机对照试验。Meta分析显示,强化降压治疗与非强化降压治疗相比,可显著降低全因死亡风险[相对危险度(RR),0.82;95%CI,0.70~0.96]、主要心血管事件(RR,0.82;95%CI,0.73~0.92,心肌梗死(RR,0.86;95%CI,0.77~0.96)、卒中(RR,0.72;95%CI,0.60~0.88,心血管死亡事件(RR,0.73;95%CI,0.58~0.92)和蛋白尿进展(RR,0.91,95%CI,0.84~0.98)。然而,强化降压治疗对非心血管死亡(RR,0.97;95%CI,0.79~1.20)、心力衰竭(HF)(RR,0.88;95%CI,0.71~1.08)和终末期肾病(ESKD)(RR,1.00;95%CI,0.75~1.33)没有明显影响。亚组分析显示,在大多数患者组中,全因病死率的降低都是一致的,即使在收缩压低于140 mmHg的患者中,强化降压治疗也有明显益处。结论对2型糖尿病而言,强化降压治疗好处较多,但还需要进一步研究,以评估低于目前推荐的强化降压治疗血压值的益处和危害。

Objective To study the effect of intensive BP lowering therapy on the mortality and cardiovascular and renal prognosis of type 2 diabetic patients.Methods The randomized controlled trials(RCTs)that met the inclusion criteria of the study were retrieved by searching PubMed,EMBASE,Scientific Citation Index and Cochrane Library databases.Two investigators independently extracted and collected the related data from the included trials,and used the random effects model to calculate the estimated values of each effect indicator.Results Sixteen randomized controlled trials were included.Meta-analysis showed that intensive BP control reduced the risk of all-cause mortality[relative risk(RR),0.82;95%CI,0.70-0.96],major cardiovascular events(RR,0.82;95%CI,0.73-0.92,myocardial infarction(RR,0.86;95%CI,0.77-0.96),stroke(RR,0.72;95%CI,0.60-0.88,cardiovascular death events(RR,0.73;95%CI,0.58-0.92),and the progression of albuminuria(RR,0.9195%CI,0.84-0.98)more significantly than the less intensive BP lowering therapy did.However,intensive BP lowering treatment had no significant effect on non-cardiovascular death(RR,0.97;95%CI,0.79-1.20),heart failure(HF)(RR,0.88;95%CI,0.71-1.08)or end-stage kidney disease(ESKD)(RR,1.00;95%CI,0.75-1.33).The reduced all-cause mortality in subgroup analysis was consistent across most patient groups.Moreover,in patients with systolic blood pressure lower than 140 mmHg,intensive BP control was of obvious benefit.Conclusions Our data shows that intensive BP lowering control is more conducive to patients with type 2 diabetes than less intensive control.However,more research is needed to clarify the benefits and hazards of BP targets lower than currently recommended in intensive BP lowering treatment.