从循证医学看降压治疗的新进展,广东省人民医院心内科广东省心血管病研究所陈鲁原,内 容,改善糖尿病患者的预后，强化降压宜优先来自ADVANCE、ACCORD研究的启示 迎接优化联合降压治疗的时代,Registration,Randomisation,Perindopril-indapamide combination + Intensive glucose control,Perindopril-indapamide combination + Standard glucose control,Placebo+ Intensive glucose control,Placebo+ Standard glucose control,End of follow-up (4-5 years),Study design Blood glucose lowering intervention,6-week run-in phase on active perindopril and indapamide,全球20个国家215个协作单位参加研究 随机11140例（其中我国随机3293例）,ADVANCE Collaborative Group. Lancet 2007; 370: 82940,Blood pressure reduction, 2.2 mmHg (95% CI 2.0-2.4); p0.001, 5.6 mmHg (95% CI 5.2-6.0); p0.001,Diastolic,Systolic,Placebo,Perindopril-Indapamide,Mean Blood Pressure (mmHg),65,75,85,95,105,115,125,135,145,155,165,Follow-up (Months),R,6,12,18,24,30,36,42,48,54,60,BP = 145/81 mm Hg baseline,Lancet 2007;370:829-40,11140例2型糖尿病患者,ADVANCE: 心血管和非心血管死亡率,Cardiovascular,Follow-up (months),6,12,18,24,30,36,42,48,54,60,常规治疗,常规治疗+Perindopril-indapamide,Non-cardiovascular,Follow-up (months),6,12,18,24,30,36,42,48,54,60,Relative risk reduction 18%; p=0.027,Relative risk reduction 8%; p=0.41,5%,5%,Cumulative incidence (%),常规治疗,常规治疗+Perindopril-indapamide,强化组70%患者采用达美康缓释片4片治疗，平均剂量3.2片,2008年6月6日第68届ADA年会宣布ADVANCE降糖分支研究结果,强化降糖方案可显著减少微血管病变事件，但不减少大血管事件,第68届ADA年会（ 2008.6.6）,Standard,Intensive,A1C goal 6% 7.5%,10,000 Subjects With Type 2 Diabetes Double 22 Design,Lipid trial: Statin for LDL for all patients, then randomize to fenofibrate or placebo.,NHLBI and ACCORD Study Web sites. Available at: www.accordtrial.org/public/purpose.cfm.,Action to Control Cardiovascular Risk in Diabetes (ACCORD),Systolic BP 120 mm Hg 140 mm Hg,