中国部分地区糖尿病患者未强化降压治疗的调查分析

Reasons for not intensifying antihyperteusive treatment to diabetes in some regions of China

目的了解我国糖尿病患者高血压的控制率和达标率，并分析糖尿病患者未强化降压治疗的原因。方法对中国部分地区连续筛查符合入选标准高血压患者5063例中伴有糖尿病的1993例患者进行基线调查，医生根据日常医疗实践常规自主选用不同药物及剂量，并前瞻性进行2、4、8周和12周治疗达标观察。结果本组高血压人群糖尿病的患病率为39．2％（1993／5063），基线平均血压为157／91mmHg。医生为患者制定的目标血压平均为129／80mmHg，根据不同高血压级别和高危程度，为患者制定的目标血压值不同（P〈0.0001）。以血压〈130／80mmHg为标准，最后一次随访血压达标625例（31．4％）；伴有大量白蛋白尿的糖尿病患者中，以血压〈125／75mmHg为标准，最后一次随访达标353例（17．7％）。4次随访分别有38．5％、34．5％、30．2％和22．8％的患者血压未达标而医生未调整治疗方案，主要原因是医生认为患者血压接近达标，降压有效继续观察。本组达标患者平均服用了2种降压药物，有的甚至服用4—5种降压药才能达标，最常用的降压药物为血管紧张素Ⅱ受体拮抗剂和钙通道阻滞剂。噻嗪类利尿剂在随访过程中使用比例逐渐上升。结论中国地区高血压患者糖尿病的患病率高，医生为其制定的目标血压值以及实际达标情况由于许多主客观因素的存在与指南还存在一定差距。糖尿病患者的血压达标率明显低于总体达标率。

Objective To prospectively evaluate the current situation of blood pressure control in the type 2 diabetics in some regions of China. Methods Totally 5063 consecutive patients with hypertension were investigated. Among them 1993 with diabetes underwent baseline survey. Individualized target blood pressures were set by physicians. Four follow-up visits, in weeks 2, 4, 8, and 12 were performed to monitor the achievements of these targets and the reasons for not modifying antihypertensive treatments were analyzed when the blood pressure goals were not reached. Results The prevalence of diabetes among the hypertensive patients was 39.2%. The target blood pressure values defined by the physicians at baseline survey varied with the grade and degree of hypertension. 31.4% of the patients reached the target blood pressure goals（ BP 〈 130/80 mm Hg）at week 12. The reasons for not intensifying antihypertensive treatment when the blood pressure targets were not achieved were manifold. The main reasons were as follows, the physicians considered that the BP value was close to the target, longer treatment and waiting for full drug effect were needed, etc. On average, 2 different antihypertensive agents were used to achieve BP target and some patients used 4-5 different drugs. The most frequent agents used were angiotensin II receptor antagonist and calcium channel blockers. The use of thiazide-type diuretics increased from the first visit to the last visit （weeks 12）. Conclusion The co-prevalence of hypertension and diabetes in China is high and the target blood pressure set by physician is almost 130/80 mm Hg as defined in guidelines. Only about 31.4% of patients have reached their goals 12 weeks after treatment. There are many subjective and objective reasons responsible for not intensifying antihypertensive treatment when the blood pressure targets are not achieved. Hypertension in diabetes is poorly controlled compared with that in the whole population.