抗高血压药物引起的糖尿病不容忽视(英文）.ppt

DRUG INDUCED DIABETES DURING ANTIHYPERTENSIVE THERAPY IS IMPORTANT - BUT CHINESE SOCIETY OF HYPERTENSION MICHAEL ALDERMAN MAY 22, 2008 Prevalence of diabetes among Chinese adults aged 35–64 years in the 1994 Chinese National Survey (10) and 2000–2001 InterASIA Study 65% of Mortality in people with Diabetes is CVD Systolic BP and CV Death in MRFIT Annual Incidence of Diabetes in Hypertensive Patients SHEP untreated controls = 2.7% SHEP treated = 3.9% NHANES 18 year Follow-upNOD in US Women by Baseline BP THE ISSUES CONSEQUENCES OF NOD CVD AND non-CVD HOW DO ANTIHYPERTENSIVE DRUGS EFFECT INCIDENCE OF NOD AND CVD ONSEQUENCES? HOW SHOULD NOD EFFECT MANAGEMENT FOR CVD PROTECTION? Non-CVD Consequences of NOD Impaired BP control Behavioral and Psychological Microvascular consequences (?) ? Medical care demands Treatment changes CVD Consequences Short and Long term Antihypertensive Drug Related Effect of ACEIs and ARBs on CVD Mortality Age-gender–adjusted in treatment CVD and non-CVD by baseline FBG among hypertensive patients. Myocardial infarction (fatal and nonfatal) in hypertensive patients according to DM status Diabetes Incidence - 4 Years(follow-up FBS ? 126 mg/dL for those 126 mg/dL at baseline) Ramipril v. Placebo in high risk patients with IGT at baseline Ramipril v. Placebo CVD non-CVD Outcomes CONCLUSIONS FROM SHEP + Chlorthalidone Rx of hypertension improves long-term outcomes. The diabetes related to chlorthalidone therapy has better prognosis than diabetes at baseline. The benefit of chlorthalidone-based therapy on long-term total and CV mortality is most pronounced in hypertensive patients with diabetes. Reduction in major CVD among 6,000 DM in HPS associated with 38/89 ? LDL/CHOL by Statin Incidence of MI and Microvascular Endpoints by Mean SBP and HbA1c in UKPDS UNCERTAINTY CONTINUESACCORD AND ADVANCE ACCORD - Mortality greater with HbAlc 6.4 v. 7.0-7.9% ADVANCE - No evidence of ? mortality with HbAlc 6.4 v. 7,5% Major CV Event