糖尿病患者的血压管理课件.ppt

2010版中国高血压防治指南强调：血管指标是独立于血压的心血管事件预测因素 颈动脉内中膜厚度（IMT）和粥样斑块可独立于血压水平预测心血管事件 脉搏波传导速度（PWV）增快是心血管事件的独立预测因素 IMT 内中膜厚度的五分位数 颈动脉IMT是心脑血管事件的重要指标 脑卒中的发生与颈动脉内中膜厚度 CIMT 密切相关 每千人年心梗或卒中比率（%） New England Journal of Medicine, 1999;340:14-22 Laura Tripkovic, Kathryn Hart. Summer Meeting 30 June–3 July 2008 PWV可以反映血管内皮及动脉僵硬度的变化 测量PWV PWV PWV可评估大动脉的弹性及硬度，是心血管事件的独立危险因素 PWV m/s L/ t （两个压力记录部位之间脉搏波传导距离 / 传导时间） PWV反映测量两点间的动脉节段弹性，动脉弹性降低，则PWV增加 颈-股 PWV 肱-踝 PWV 小 结 糖尿病血压管理 Thank you ! 对于糖尿病患者来说，血压的降低意味着什么呢？ 我们前面提到的UKPDS研究结果表明：血压每下降10mmHg，所有糖尿病相关终点风险降低12%，总死亡率下降12%，糖尿病相关死亡风险降低17%。不得不说血压的降低为糖尿病高血压患者带来的获益是巨大的。 Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes UKPDS 36 : prospective observational study Amanda I Adler, Irene M Stratton, H Andrew W Neil, John S Yudkin, David R Matthews, Carole A Cull, Alex D Wright, Robert C Turner, Rury R Holman on behalf of the UK Prospective Diabetes Study Group Abstract Objective To determine the relation between systolic blood pressure over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes. Design Prospective observational study. Setting 23 hospital based clinics in England, Scotland, and Northern Ireland. Participants 4801 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk. Outcome measures Primary predefined aggregate clinical outcomes: any complications or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, lower extremity amputation including death from peripheral vascular disease , and microvascular disease predominantly retinal photocoagulation . Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 10 mm Hg decrease in updated mean systolic blood pressure adjusted for specific confound