Effects of intensive blood pressure lowering treatment on mortality and cardiovascular and renal prognoses in patients with type 2 diabetes mellitus: a meta-analysis
MA Yufei1,2, CHEN Wei3, XU Weihao1,2, YANG Wenyi1,2, CAO Jian1
1. Department of Cardiology,Second Medical Center of Chinese PLA General Hospital,National Clinical Research Center for Geriatric Diseases,Beijing 100853,China; 2. Medical School of Chinese PLA,Beijing 100853,China; 3. The Outpatient Department,Beijing Carrison Fengtai No.16 retired cadres rest home,Beijing 100071,China
Abstract：Objective To study the effect of intensive BP lowering therapy on the mortality and cardiovascular and renal prognosis of type 2 diabetic patients.Methods The randomized controlled trials (RCTs) that met the inclusion criteria of the study were retrieved by searching PubMed,EMBASE,Scientific Citation Index and Cochrane Library databases.Two investigators independently extracted and collected the related data from the included trials,and used the random effects model to calculate the estimated values of each effect indicator.Results Sixteen randomized controlled trials were included.Meta-analysis showed that intensive BP control reduced the risk of all-cause mortality [relative risk (RR),0.82;95% CI,0.70-0.96],major cardiovascular events (RR,0.82;95% CI,0.73-0.92,myocardial infarction (RR,0.86;95% CI,0.77-0.96),stroke (RR,0.72;95% CI,0.60-0.88,cardiovascular death events (RR,0.73;95% CI,0.58-0.92),and the progression of albuminuria (RR,0.91 95% CI,0.84-0.98) more significantly than the less intensive BP lowering therapy did.However,intensive BP lowering treatment had no significant effect on non-cardiovascular death (RR,0.97;95% CI,0.79-1.20),heart failure (HF) (RR,0.88;95% CI,0.71-1.08) or end-stage kidney disease (ESKD) (RR,1.00;95% CI,0.75-1.33).The reduced all-cause mortality in subgroup analysis was consistent across most patient groups.Moreover,in patients with systolic blood pressure lower than 140 mmHg,intensive BP control was of obvious benefit.Conclusions Our data shows that intensive BP lowering control is more conducive to patients with type 2 diabetes than less intensive control.However,more research is needed to clarify the benefits and hazards of BP targets lower than currently recommended in intensive BP lowering treatment.
马宇飞, 陈薇, 徐伟豪, 杨雯伊, 曹剑. 强化降压治疗对2型糖尿病患者病死率及心血管和肾脏预后影响的荟萃分析[J]. 武警医学, 2021, 32(1): 10-14.
MA Yufei, CHEN Wei, XU Weihao, YANG Wenyi, CAO Jian. Effects of intensive blood pressure lowering treatment on mortality and cardiovascular and renal prognoses in patients with type 2 diabetes mellitus: a meta-analysis. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(1): 10-14.
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2021, Vol. 32 
