摘要
降压治疗降低了糖尿病(DM)患者的心血管事件发生率。但是,该治疗对亚临床动脉粥样硬化的作用尚未明确。TART(曲格列酮动脉样硬化逆转试验)是一项在胰岛素依赖性2型DM成年患者中评估曲格列酮治疗对颈动脉内膜中层厚度(CIMT)进展影响的随机试验。本文报道对TART试验中降压治疗和CIMT相关性的事后队列分析的结果。
Antihypertensive therapy reduces the incidence of cardiovascular events in people with diabetes mellitus(DM). However, the effects of treatment on subclinical atherosclerosis are less well studied. Results of a post hoc cohort analysis of the association between antihypertensive treatment and carotid artery intima-media thickness(CIMT) in the Troglitazone Atherosclerosis Regression Trial(TART), a randomized trial designed to evaluate the impact of troglitazone treatment on CIMT progression in adults with insulin-requiring type 2 DM, are reported. CIMT, blood pressure(BP), and use of antihypertensive agents were measured throughout the 2-year treatment period. In multivariable mixed-effects models, the annual rate of change in CIMT in relation to BP and duration of antihypertensive agent use, adjusting for covariates, was evaluated. Higher systolic BP was associated with a higher CIMT progression rate(p=0.03). This association was reduced by antihypertensive treatment in a duration-dependent manner(p for interaction=0.035). Adjustment for age, treatment assignment, and change in fasting glucose during the trial did not attenuate these associations. In conclusion, regular use of antihypertensive agents reduces the harmful impact of increased BP on atherosclerosis progression in patients with DM. The antiatherogenic effect of antihypertensive agents, including BP normalization and possible direct vascular wall protection, can be detected by CIMT progression using B-mode ultrasound in patients with DM.
