專題討論7:高血壓面面觀

S7-6
Treatment of Hypertension in Patients with Diabetes Mellitus
王治元Chih-Yuan Wang, MD, Ph.D
Department of Internal medicine,
Far-Eastern Memorial Hospital

  Hypertension is one of the most important risk factors for macrovascular atherosclerosis in type 2 diabetes mellitus. The coexistence of hypertension and other metabolic diseases, including obesity, dyslipidemia in the same patient is devastating to the cardiovascular system, and the results may increase the risk of stroke, or even cardiovascular mortality. Therefore, aggressive treatment of lowering blood pressure decreases the possibility of cardiovascular events and renal deterioration in type 2 diabetic patients. In Taiwan, hypertension-related diseases are the leading causes of mortality and are estimated for 31.18% deaths. Because hypertension is an important risk factor for cardiovascular, cerebrovascular and renal diseases in Western and Asian populations, we must collect enough information to estimate the prevalence. Here, we collect recent studies of hypertension prevalence in Taiwan, and we also compared the data with those of NAHSIT (1993-1996). The results of recent investigations indicate hypertension is highly prevalent in Taiwan. In addition, hypertension is one of the criteria for metabolic syndrome, which will be a silent killer for general population in the future. The urgent need to develop standard therapeutic strategies to treat hypertension and related complications should be further delicately evaluated.

  The update data of Angitensin II receptor blockers (ARBs) might provide a brand new therapeutic strategy in hypertensive entity. The comparative studies between ACE inhibitor and a selective AT1 receptor blocker suggest that the systemic hemodynamic effects of ACE inhibition are mostly due to suppression of Ang II. The favorable hemodynamic properties of ACE inhibition have already established to be a therapeutic choice in hypertensively congestive heart failure. Comparative studies of ARBs against ACE inhibitors revealed similar decreases of systolic and diastolic blood pressure and the same response rates on monotherapy, with better tolerability of the ARB in all age groups. Several large multicenter randomized outcome trials in the last couple of years have proven ARBs to be cardioprotective and nephroprotective in type 2 diabetes mellitus. On the other hand, dihydropyridine calcium channel blockers provides effective blood pressure lowering in combination with ACEI or ARB, and non- dihydropyridine calcium channel blockers also revealed renal protection effects via improving proteinuria in short term studies. Selective beta-blockers still play important roles in post-myocardial infarction status. Certainly, diuretics, even to be first line medication, are still pivotal in combination with other anti-hypertensive medication, especially with ACEI or ARB.