糖尿病合并高血压患者降压目标的变迁

Changes of Blood Pressure Goal of Antihypertensive Therapy in Diabetic Patients with Hypertension

高血压是糖尿病的常见并发症或伴发病,它们的并存增加了心脑血管疾病、肾病、视网膜病变的发生风险。降压可改善此类患者的预后,但降压的目标一直存在争议。由于糖尿病合并高血压的心血管风险较大,早年的指南强调严格控制血压,目标为130/80 mm Hg(1 mm Hg=0.133 k Pa)。但与普通高血压降压目标(140/90 mm Hg)相比,糖尿病合并高血压患者的血压降到130/80 mm Hg并不能降低心血管的病死率。且由于严格降压应用的药物种类较多、剂量较大,使得不良反应的发生率更高。因此,近年来糖尿病合并高血压的降压目标放宽到了140/80~90 mm Hg,而最佳的降压目标仍需积极探索。

Hypertension is a common complication or comorbidity of diabetes. Co-existence of diabetes and hypertension increases the risk for occurrence of cardiovascular and cerebrovascular events, kidney disease, and retinopathy. Antihypertensive therapy could significantly improve the prognosis of these patients, but blood pressure goal has long been controversial. Since diabetic patients with hypertension have higher cardiovascular risk, early guidelines emphasized strict control of blood pressure, with the goal of 130/80 mmHg（ 1 mmHg = 0. 133 kPa）. However, compared with goal blood pressure 140/ 90 mmHg in ordinary hypertensive patients, blood pressure goal 130/80 mmHg did not reduce cardiovascular mortality in diabetic patients with hypertension. Due to more usage of antihypertensive drugs, the incidence of adverse events is higher. Therefore, in recent years, the goal of blood pressure control for diabetic patients with hypertension has been relaxed to 140/ 80-90 mmHg,and the optimal goal of blood pressure still needs to be further explored.