糖尿病合并高血压的可能机制和降压药选择策略

The pathogenic mechanisms of complicated hypertension in diabetes mellitus and the selection of antihypertensive medicine

糖尿病合并高血压使患者心、脑血管事件和终末期肾病的发病危险明显增加。本文简述了糖尿病合并高血压的可能机制,并对糖尿病合并高血压患者的降压药选择进行了复习。目前的总体认识为:血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体阻滞剂、钙通道阻滞剂对糖代谢和糖尿病本身的作用为中性,甚至可产生一定的有益作用;而利尿剂、β受体阻滞剂则可能对糖代谢产生不利影响,特别是当两者合用时,但现有的研究资料尚不能明确证实某一类型降压药具有明显的优越性,因此,无论使用何种药物,使患者的血压迅速、稳定地控制在130/80mmHg以下才是最重要的目标。

The risks of cardiovascular events,cerebrovascular accident and end stage renal disease are higher in patients with both diabetes and hypertension than patients with either disease alone.In this paper,the author reviewed the possible mechanisms of diabetes complicated with hypertension and the characteristics of antihypertensive medicine.ACE inhibitors,angiotensin receptor blockers,and calcium channel blockers seem to have neutral or beneficial effects,whereas β-blockers and thiazide diuretics tend to be worsen insulin resistance or glycemic control,especially in patients with both β-blockers and thiazide diuretics.However,there are no comparative trial showing that one of them is much more superior than others.Clinicians should be aware of that the first goal of treating hypertension in diabetes patients is to aggressively reduce blood pressure to lower than 130/80 mmHg in order to get maximal benefit.