中老年新发2型糖尿病患者合并高血压的现状和治疗

摘要

Objective To investigate the prevalence of hypertension in middle-aged or elderly with newly-onset type 2diabetes in China and to clarify the strategy of intensive blood-pressure control in such population. Methods Retrospective analysis was performed in CDCPS and the prevalence and awareness rate of hypertension were analyzed in newly-onset type 2 diabetes whose age were from 50 to 75 years old in 10 centers of China. 771 hypertensive patients were divided into 4 groups (A:untreated;B:monodrug therapy; C: dual-drug therapy; D: muLti-drug therapy ) at the beginning of study, and blood pressure was monitored within 20-month follow-up duration monthly. Results 1. The prevalence and the awareness rate of hypertension were 48.4％ and 81.0％,respectively. The prevalence increased with age. 2. 78.8％ hypertensive patients had received regular anti-hypertension therapy before enrolled the study. Except the D group,all other kinds of regimen significantly reduced the systolic blood pressure and kept it stable during the 20-month intervention,and the similar trend could be seen in diastolic blood pressure but without statistic significance.Compared with baseline data, systolic blood pressure and diastolic blood pressure (except D group)of the 20th month in four groups were all decreased significantly (P＜0.05). Conclusions The prevalence of hypertension was high in middle-aged and elderly newlyonset type 2 diabetes. According to the baseline blood pressure level and hypertension course,the anti-hypertension strategies of mono-drug or multi-drug therapeutic regimens with ACE1 or ARB as first choice based on life-style intervention could further decrease the blood pressure and keep it stable.%目的 了解我国中老年新发2型糖尿病合并高血压患者的现状及强化血压控制过程中的治疗策略.方法 回顾性分析中国2型糖尿病及其并发症预警干预的研究(chinese diabetes complication prevention study,CDCPS)Ⅰ期研究中年龄50-75岁新发2型糖尿病患者合并高血压的患病率和知晓率,根据血压控制方式分为4组(A组未用药;B组1种药;C组2种药:D组3种药),分析在第20次随访(第20个月)的血压情况与不同治疗方案的关系.结果 (1) 771例患者高血压患病率为48.4%.知晓率为81.0%.患病率随年龄增长而增加.(2)入组前高血压的治疗率为78.8%,入组后患者高血压的病程和血压水平与治疗方案的复杂性相关.除D组外,调整后的其余治疗方案均能使患者收缩压达到满意控制并基本维持稳定;舒张压也有下降趋势,但无明显统计学差异.随访第20次与基线相比,除D组舒张压外,所有组的收缩压及其余3组的舒张压均有显著下降(P<0.05).结论 中老年新发2型糖尿病患者中高血压的患病率较高.根据血压基线水平和高血压病程制定包括以生活方式指导为基础,以血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)为首选的1种或≥2种的降压药物治疗方案,均能使血压有进一步的下降并达到较满意的控制.