Target Blood Pressure in Patients with Diabetes: Asian Perspective
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) trial enrolled 4733 participants with type 2 diabetes and randomized them to a target systolic blood pressure (SBP) of less than 120 mm Hg or 140 mm Hg. Despitethe significant difference in the achieved SBP, there was no significant difference in the incidence of primary outcomes. Based on this evidence, the target SBP for diabetics has been revised in the majority of major guidelines. However, there is a steeper association between SBP and stroke in Asians than other ethnicities, with stroke being the leading cause of cardiovascular mortality. This suggests that target BP in the Asian region should be tailored towards prevention of stroke. In the ACCORD study, the intensive BP treatment was associated with significant reductions in both total stroke and non-fatal stroke. The results from the ACCORD study are supported by a subgroup analysis from the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study, which showed that, in diabetic patients, the risk of stroke continues to decrease to a SBP value of 115 mm Hg with no evidence of J curve. As diabetes is highly associated with underlying coronary artery disease, there is a justified concern for adverse effects resulting from too much lowering of BP. In a post hoc analysis of 6400 diabetic subjectsenrolled in the International Verapamil SR-Trandolapril (INVEST) study, subjects with SBP of less than 110 mm Hg were associatedwith a significant increase in all-cause mortality. In the ONTARGET study, at any levels of achieved SBP, diastolic blood pressure (DBP) below 67 mm Hg was associated with increased risk for cardiovascular outcomes. As such, a prudent approach would be to target a SBP of 130–140 mm Hg and DBP of above 60 mm Hg in diabetics with coronary artery disease. In conclusion, hypertension, in association with diabetes, has been found to be significantly correlated with an elevated risk for cardiovascular events. As the association between stroke and BP is stronger in Asians, compared to other ethnicities, consideration should be given for a target BP of 130/80 mm Hg in Asians.
Abstract
Recently, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) trial enrolled 4733 participants with type 2 diabetes and randomized them to a target systolic blood pressure (SBP) of less than 120 mm Hg or 140 mm Hg. Despitethe significant difference in the achieved SBP, there was no significant difference in the incidence of primary outcomes. Based on this evidence, the target SBP for diabetics has been revised in the majority of major guidelines. However, there is a steeper association between SBP and stroke in Asians than other ethnicities, with stroke being the leading cause of cardiovascular mortality. This suggests that target BP in the Asian region should be tailored towards prevention of stroke. In the ACCORD study, the intensive BP treatment was associated with significant reductions in both total stroke and non-fatal stroke. The results from the ACCORD study are supported by a subgroup analysis from the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) study, which showed that, in diabetic patients, the risk of stroke continues to decrease to a SBP value of 115 mm Hg with no evidence of J curve. As diabetes is highly associated with underlying coronary artery disease, there is a justified concern for adverse effects resulting from too much lowering of BP. In a post hoc analysis of 6400 diabetic subjectsenrolled in the International Verapamil SR-Trandolapril (INVEST) study, subjects with SBP of less than 110 mm Hg were associatedwith a significant increase in all-cause mortality. In the ONTARGET study, at any levels of achieved SBP, diastolic blood pressure (DBP) below 67 mm Hg was associated with increased risk for cardiovascular outcomes. As such, a prudent approach would be to target a SBP of 130–140 mm Hg and DBP of above 60 mm Hg in diabetics with coronary artery disease. In conclusion, hypertension, in association with diabetes, has been found to be significantly correlated with an elevated risk for cardiovascular events. As the association between stroke and BP is stronger in Asians, compared to other ethnicities, consideration should be given for a target BP of 130/80 mm Hg in Asians.
참고문헌 (23)
- Ravid M, "Proteinuria, renal impairment, metabolic control, and blood pressure in type 2 diabetes mellitus. A 14-year follow-up report on 195 patients", Arch Intern Med, 152, pp.1225~1229 (1992)
- Pell S, "Some aspects of hypertension in diabetes mellitus", JAMA, 202, pp.104~110 (1967)
- Lipman ML, "What is the ideal blood pressure goal for patients with diabetes mellitus and nephropathy?", Curr Cardiol Rep, 14, pp.651~659 (2012)
- Stamler J, "Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial", Diabetes Care, 16, pp.434~444 (1993)
- Redon J, "Safety and effcacy of low blood pressures among patients with diabetes: subgroup analyses from the ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial)", J Am Coll Cardiol, 59, pp.74~83 (2012)
- Chobanian AV, "The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report", JAMA, 289, pp.2560~2572 (2003)
- Mancia G, "2007 Guidelines for the management of arterial hypertension:The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)", Eur Heart J, 28, pp.1462~1536 (2007)
- Mancia G, "2013 ESH", ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC), 2013, pp.31, 1281~1357
- James PA, "Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8)", JAMA, 311, pp.507~520 (2014)
- American Diabetes Association, "Cardiovascular disease and risk management", Diabetes Care, 39(Suppl 1), pp.S60~S71 (2016)
- Hansson L, "Effects of intensive blood-pressure lowering and lowdose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group", Lancet, 351, pp.1755~1762 (1998)
- Schrier RW, "Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes", Kidney Int, 61, pp.1086~1097 (2002)
- ACCORD Study Group, "Effects of intensive blood-pressure control in type 2 diabetes mellitus", N Engl J Med, 362, pp.1575~1585 (2010)
- Cooper-DeHoff RM, "Tight blood pressure control and cardiovascular outcomes among hypertensive patients with diabetes and coronary artery disease", JAMA, 304, pp.61~68 (2010)
- Lawes CM, "Blood pressure and cardiovascular disease in the Asia Pacific region", J Hypertens, 21, pp.707~716 (2003)
- Bangalore S, "Blood pressure targets in subjects with type 2 diabetes mellitus", impaired fasting glucose: observations from traditional and bayesian random-effects meta-analyses of randomized trials, 2011, pp.123, 2799~2810
- Kawamori R, "Relation between cardiovascular complications and blood pressure", blood glucose control in diabetic patients with hypertension receiving long-term candesartan cilexetil therapy: challenge-DM study, 2009, pp.83, 241~248
- Ogihara T, "Relationship between the achieved blood pressure and the incidence of cardiovascular events in Japanese hypertensive patients with complications: a sub-analysis of the CASE-J trial", Hypertens Res, 32, pp.248~254 (2009)
- Pohl MA, "Independent and additive impact of blood pressure control and angiotensin II receptor blockade on renal outcomes in the irbesartan diabetic nephropathy trial: clinical implications and limitations", J Am Soc Nephrol, 16, pp.3027~3037 (2005)
- Chiang CE, "2015 guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the management of hypertension", J Chin Med Assoc, 78, pp.1~47 (2015)
- Shimamoto K, "The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014)", Hypertens Res, 37, pp.253~390 (2014)
- Haffner SM, "Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction", N Engl J Med, 339, pp.229~234 (1998)
- Brunström M, "Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus:systematic review and meta-analyses", BMJ, 352, pp.i717~ (2016)