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[ADA2012]糖尿病合并高血压研究新进展
——美国凯斯西储大学医学院临床研究中心主任Jackson T. Wright教授访谈
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作者:J.T.Wright 2012/6/18 15:46:00    加入收藏
内容概要:Wright教授:目前,研究证据最充分的亚组人群是伴有肾病和蛋白尿的人群。这个人群中的研究证据最强,但即使这个人群中也没有直接的头对头比较不同血压目标值的研究。这个人群也许是唯一有证据的亚组人群。

  <International Diabetes>: Is there any subgroup for which you feel there is strong evidence for recommending a blood pressure below 130/80mmHg?
Prof.Wright:The one subgroup where the evidence is strongest is in those with nephropathy and proteinuria. That group is where the data are probably strongest but even in that population there is no direct head-to-head comparison of one blood pressure target versus another. That would probably be the only group.

  《国际糖尿病》: 请问哪些亚组的人群有血压控制到130/80mmHg以下的强研究证据?
Wright教授:目前,研究证据最充分的亚组人群是伴有肾病和蛋白尿的人群。这个人群中的研究证据最强,但即使这个人群中也没有直接的头对头比较不同血压目标值的研究。这个人群也许是唯一有证据的亚组人群。

  <International Diabetes>:In your presentation you outlined that most of our evidence comes from achieved blood pressure. Could you explain what problems you believe exist with achieved blood pressure?
Prof.Wright:Patients who achieve a lower blood pressure are patients who principally have less severe disease at the beginning. They typically have fewer comorbidities. They have lesser evidence of target organ damage and in some studies are the problem patients due to less adherence. This has been shown in analyses of randomized trials of blood pressure targets and if you look at the distribution of blood pressures within the randomized targets, if you look at those patients who for the same target have a higher blood pressure versus a lower blood pressure, those patients who achieve the lower blood pressure are generally less sick than those who are unable to achieve the blood pressure target.

  《国际糖尿病》: 您在演讲中提到,我们主要的研究证据均来自实际达到的血压值。您能否解释一下,实际达到的血压值存在哪些问题?
Wright教授:血压值降低到较低水平的患者往往开始时病情较轻,合并症较少,靶器官损害的证据也较少,而在一些研究中,这些患者往往由于依从性差而成为问题患者。血压达标的随机对照研究中已经显示出了这一点,对随机对照研究结果进行分析后发现,尽管设定的目标血压值相同,但最终达到目标血压值的患者比最终不能达到目标血压的患者病情轻。

  <International Diabetes>: But if you go by the randomized groups you still end up with mixed groups.
Prof.Wright: You end up with mixed groups but if you achieve two different targets, it means the patients with comorbidities and less severe disease will be randomized similarly to the two different blood pressure targets.

  《国际糖尿病》: 但如果试验是随机分组的,每个组的血压值情况就会是混合的。
Wright教授:的确,每组的血压值结束时是混合的,但如果最终达到的血压值不同,就意味着有合并症的和病情较轻的患者被相似地随机化分到两个不同的血压目标组。

  <International Diabetes>: You did show in the African-American Study of Kidney Disease and Hypertension (AASK) trial that the variation within the groups may be confounding the end results.
Prof.Wright:The AASK trial actually looked at two randomized groups and actually saw no difference in outcome based upon in the two randomized groups.  Those randomized to the usually recommended blood pressure target had a similar renal outcome compared to those randomized to an even lower blood pressure target. If you looked within each group, there were patients who achieved the targets and those who did not. It is within those randomized targets that you see the heterogeneity in terms of blood pressure response and in terms of outcome.

  《国际糖尿病》: 您提到在非洲-美国肾脏病与高血压研究(AASK)中,组内变异可能会使研究结果产生混杂偏倚,是这样吗?
Wright教授: AASK试验观察了2组随机化的受试者,血压控制目标分别为常规推荐值和低于常规推荐值,结果发现两个组的肾脏结局相似,因此认为两组结果没有差异。但如果进一步对每组分别进行分析,又可以分别划分为血压达标亚组和未达标亚组。只有对随机的血压值进行观察,才能看到血压的治疗反应的 异质性和临床结局的异质性。
 



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网站用户: 殷学 时间:2012/9/29 17:14:23
AASK研究血压达标能够有效降低蛋白尿。

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