不同服药依从性所致血糖升高对心脑血管事件的影响

Effects of different medication compliance - induced hyperglycemia on cardio - cerbrovascular events

目的探讨以氢氯噻嗪（HCTZ）为基础的降压治疗期间，不同服药依从性所致的血糖升高对原发性高血压患者心脑血管事件的影响。方法选择轻、中度原发性高血压患者829例，人选患者经安慰剂洗脱2周和HCTZ导入6周后随机给予HCTZ12．5mg／d或HCTZ12．5mg／d＋螺内酯20mg／d或HCTZ12．5mg／d＋卡托普利25mg每天2次治疗7年。根据患者的服药依从性分为依从组（385例）和非依从组（192例）；依据患者服药后各次空腹血糖水平的平均值，再分别分为血糖升高者（血糖均值i〉7mmoL／L）与血糖正常者（血糖均值〈7mmol／L）。治疗期间每月随访1次，监测血压，记录终点事件，每年进行一次血生化指标检测。随访9年。结果随访结束时共计发生一t7脑血管事件98例，其中依从组发生心脑血管事件52例（13．5％），非依从组发生心脑血管事件46例（24．0％），非依从组心脑血管事件率高于依从组，差异有统计学意义（P〈0．05）。依从组血糖升高组终点事件的发生率（28．0％）低于非依从组（37．5％），两者比较差异无统计学意义（P〉0．05）。结论以噻嗪类利尿剂为基础抗高血压治疗期间，不同服药依从性所致的血糖升高与临床心脑血管终点事件的发生无相关性。

Objective To investigate the effects of hyperglycemia due to hydrochlorothiazide - based antihypertensive treatment on cardiovascular and cerebrovascular events. Methods A total of 829 patients with mild to moderate hypertension were recruited. They were randomly given HCTZ 12.5 mg qd or （ HCTZ 12.5 mg qd and spironolactone 20 mg qd） or （ HCTZ 12.5 nag qd and captopril 25 mg bid） after 2 weeks placebo elution period and 6 weeks leading period. According to the patient＇s medication compliance, they were divided into compliance group （385 cases ） and non -compliance group（ 192 cases）. Based on average fasting glucose levels, the patients were sub- grouped by elevated blood glucose （mean blood glucose ~〉 7 mmol/L） and normal blood glucose （mean blood sugar 〈 7 mmol/L）. During the follow- up period, the blood pressure and the outcomes were recorded monthly, and blood biochemical detection was performed once a year. The follow - up time lasted nine years. Results Endpoint Comparison： by the end of follow - up, there were 98 cases of cardiovascular and cerebrovascular events totally including 52 cases （13.5%） in compliance group and 46 cases （24.0%） in non - compliance group with a statistical significance between the two groups （ P 〈 0.05 ）. Medication compliance did not decrease the incidence of cardiovascular and cerebrovascular events in patients with elevated blood glucose, with compliance group of 28.0% and non- compliance group of 37.5% （P 〉 0. 05 ）. Conclusion With thiazide diuretics - based autihypertensive treatment, there is no correlation between blood glucose and clinical cardiovascular events.