Heart protection: a key target in the management of patients with diabetes.

Jean-Jacques Mourad, Sylvain Le Jeune
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引用次数: 2

Abstract

Cardiovascular disease is responsible for 70% of all mortality among patients with type 2 diabetes and is also a major contributor to diabetes-related healthcare costs. The ADVANCE trial clearly demonstrated that a simple and easily applicable pharmacological strategy based on perindopril/indapamide fixed combination could substantially reduce total and cardiovascular mortality (-14% and -18%, respectively). The observed benefits were largely caused by a substantial decrease in systolic blood pressure (SBP), confirming the need to have ambitious therapeutic goals in such high-risk patients. This point is of importance because most of the patients included in the trial were being treated for hypertension, and baseline brachial SBP and diastolic blood pressure at inclusion were very close to normal. Previous mechanistic studies have highlighted the positive effect of perindopril/indapamide fixed combination on large artery function as well as on microvascular structure. For example, in the REASON trial, in patients treated with perindopril/indapamide, the decrease in central aortic SBP, which closely correlated with the decrease in left ventricular hypertrophy, reflected a significant improvement in large artery function and a changing pattern in both peripheral reflection coefficients and structural arteriolar network. These data are supported by those from other studies, which show increases in coronary blood flow reserve with perindopril/indapamide treatment. In conclusion, normalization of SBP, pulse pressure, arterial function and myocardial perfusion, a haemodynamic profile known to improve survival in the hypertensive populations at high cardiovascular risk, seems to be more easily achieved when a strategy based on the perindopril/indapamide combination is applied.

心脏保护:糖尿病患者管理的关键目标。
心血管疾病占2型糖尿病患者总死亡率的70%,也是糖尿病相关医疗费用的主要来源。ADVANCE试验清楚地表明,基于培哚普利/吲达帕胺固定联合的简单且易于应用的药理学策略可以显著降低总死亡率和心血管死亡率(分别为-14%和-18%)。观察到的益处主要是由收缩压(SBP)的显著降低引起的,这证实了对此类高危患者制定雄心勃勃的治疗目标的必要性。这一点很重要,因为试验中的大多数患者正在接受高血压治疗,并且纳入时的基线肱收缩压和舒张压非常接近正常。先前的机制研究强调了培哚普利/吲达帕胺固定联合对大动脉功能和微血管结构的积极作用。例如,在REASON试验中,经培哚普利/吲达帕胺治疗的患者,中央主动脉收缩压的降低与左室肥厚的降低密切相关,反映了大动脉功能的显著改善,外周反射系数和结构小动脉网络的改变模式。这些数据得到了其他研究的支持,这些研究表明培哚普利/吲达帕胺治疗增加了冠状动脉血流储备。综上所述,在使用培哚普利/吲达帕胺联合用药的策略时,收缩压、脉压、动脉功能和心肌灌注的正常化(已知可提高心血管高危高血压人群的生存率)似乎更容易实现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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