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1、BenefitsofTightBloodPressureControlinDiabeticpatientswithHypertension2011,June03,嚴逢杰醫師DiabetesCare,Volume34,Supplement2,May2011DiabeticpatientsarecharacterizedbyasignificantlyhigherriskofCVeventscomparedwithnondiabeticindividuals,withdiabetesitselfbeingconsidere
2、daCVDequivalent.(1-4)ObservationaldatafromUKPDSreportedacontinuouspositivecorrelationbetweenthelevelofSBPandtheriskofdevelopingmacro-andmicrovascularcomplicationsinT2Dp’ts,withoutanyevidenceofBPthresholdlevel.(5)Withknownsynergisticinteractionofhypertensionanddi
3、abetesasCVrisk,optimalBPcontrolisparticularlyimportantinhypertensivep’twithDM.(7-11)TheUKPDSwasformallyclosein2007,i.e.,30yearsafteritsoutset(開端）,thusbeingoneofthelongesttrialsevermade.Themainaimofthisstudywastoestablishwhether,inp’twithT2D,intensiveglycemiccont
4、rolmightreducetheriskofvascularcomplications,anditsresulthaveprofoundlyinfluencedthemanagementofT2D.(12-14)TheHypertensioninDiabetesStudy(HDS),embeddedintheUKPDSin1987,confirmedthathypertensionisamajorriskfactorforCVDinT2Dp’t(16-18)andaddressedtheimportanceofati
5、ghtBPcontrolinhypertensivep’twithT2D(19).Aftermedian8.5yearspost-trialfollow-upAggregateEndpoint19972007AnydiabetesrelatedendpointRRR:12%9%P:0.0290.040MicrovasculardiseaseRRR:25%24%P:0.00990.001MyocardialinfarctionRRR:16%15%P:0.0520.014All-causemortalityRRR:6%13
6、%P:0.440.007RRR=RelativeRiskReduction,P=LogRankLegacyEffectofEarlierGlucoseControlTheDiabetesControlandComplicationsTrial/EpidemiologyofDiabetesInterventionsandComplications(DCCT/EDIC)StudyResearchGroup.NEnglJMed2005;353:2643-2653CumulativeIncidenceoftheFirstofA
7、nyofthePredefinedCardiovascularDiseaseOutcomes(PanelA)andoftheFirstOccurrenceofNonfatalMyocardialInfarction,Stroke,orDeathfromCardiovascularDisease(PanelB)42%57%LegacyEffectNEJM2008;359:1565-76BMJ1998;307:703-13Mediandurationoffollow-upwas8.4yrs. Tightvsconventi
8、onal:143/82vs154/88mmHgDMrelatedevents↓24％DMrelateddeath↓32％Microvascular↓37％Stroke↓44%Posttrialf/umedianduration:8yrsNoLegacyeffectPossibleroleofsuboptimalBPlowering
