2005年美國糖尿病學會針對糖尿病合併高血壓之標準治療建議

2005 ADA Standard Recommendations for Treatment of Diabetes with Hypertension

郝立智(Lyh-Jyh Hao) ； 楊純宜(Chwen-Yi Yang) ； 顧長生(Chang-Sheng Ku) ； 柴國樑(Kuo-Liang Chai)

《內科學誌》 16卷3期 (2005/06) Pp. 107-112

https://doi.org/10.6314/JIMT.2005.16(3).01

摘要

高血壓（定義爲收縮壓大於等於140 mmHg且／或舒張壓大於等於90 mmHg）是糖尿病的常見合併症，影響大多數的糖尿病患並且根據糖尿病的類型、年齡、肥胖程度和種族不同而有所不同。高血壓是心血管疾病如心肌梗塞、腦中風與周邊血管疾病等大血管病變的危險因子，也是視網膜病變與腎臟病變兩種小血管病變的危險因子。隨機的臨床實驗已顯示糖尿病患將收縮壓降至130 mmHg以下和舒張壓降至80 mmHg以下對於減低心血管疾病如心肌梗塞、腦中風和腎臟病變的好處。流行病學研究分析發現糖尿病患血壓超過115/75 mmHg和心血管疾病的發生率與死亡率增加有關。因此，以130/80 mmHg當作糖尿病患血壓控制的目標是合理的。
非藥物性的治療方法在非糖尿病患的高血壓病人證明是有效的，包括限鈉、減重、增加攝取水果、蔬菜和低脂食物，減少飲酒量、運動等；並且對血糖及血脂肪也具有改善效果。使用降血壓藥物，包括血管張力素轉換酵素抑制劑(Angiotensin-converting enzyme inhibitors; ACEI)、昇壓素接受器阻斷劑(Angiotension receptor blockers; ARB)、β阻斷劑(β-blockers)、利尿劑(Diuretics)、鈣離子阻斷劑（Calcium channel blockers；簡稱CCB）來降低血壓目前已有很好的監測試驗證實在心血管疾病的良好效果。若血壓在160/100 mmHg以上，就必需馬上接受藥物治療並且經常追蹤。對於這些病人，其他的心臟血管疾病的危險因子，包括肥胖症、高血脂症、抽煙、微白蛋白尿的存在和血糖的控制應該仔細地評估和治療，多數患者需要三種以上的降壓藥，才能達到理想血壓值。

關鍵字

糖尿病 ； 高血壓 ； 心血管疾病

並列摘要

Hypertension (HTN) (BP≧140/90 mmHg) is a common comorbidity of diabetes, affecting the majority of people with diabetes, depending on type of diabetes, age, obesity, and ethnicity. HTN is also a major risk factor for CVD and microvascular complications such as retinopathy and nephropathy. Randomized clinical trials have demonstrated the benefit (reduction of CHD events, stroke, and nephropathy) of lowering BP to ＜130 mmHg systolic and ＜80 mmHg diastolic in individuals with diabetes. Epidemiologic analyses show that BP ＞115/75 mmHg is associated with increased cardiovascular event rates and mortality in individuals with diabetes. Therefore, a target BP goal of ＜130/80 mmHg is reasonable. Nonpharmacological strategies include reducing sodium intake and body weight; increasing consumption of fruits, vegetables, and low-fat dairy products; avoiding excessive alcohol consumption; and increasing activity levels have been shown to be effective in reducing BP in nondiabetic individuals and may also positively affect glycemia and lipid control. Lowering of BP with regimens based on antihypertensive drugs, including ACE inhibitors, angiotensin receptor blockers (ARBs), β-blockers, diuretics, and calcium channel blockers, has been shown to be effective in lowering cardiovascular events. Systolic BP≧160 mmHg or diastolic BP≧100 mmHg, however, mandates that immediate pharmacological therapy be initiated and should be seen as often as needed. In these patients, other cardiovascular risk factors, including obesity, hyperlipidemia, smoking, presence of microalbuminuria, and glycemic control, should be carefully assessed and treated. Many patients will require three or more drugs to reach target goals.

並列關鍵字

Diabetes mellitus, DM ； Hypertension, HTN ； Cardiovascular disease, CVD