数项临床试验表明，不可控性的高血压是心脏、血管、肾脏及脑血管疾病发展，并发症和死亡的主要危险因素。然而，即使轻度的血压下降也能减少并发症发病率和死亡率。[5]Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 May 15;71(19):e127-248.https://www.sciencedirect.com/science/article/pii/S0735109717415191?via%3Dihubhttp://www.ncbi.nlm.nih.gov/pubmed/29146535?tool=bestpractice.com 还需要进一步的研究来确认糖尿病的最佳血压目标。
在一项随机临床试验 (ACCORD) 中，对于2 型糖尿病患者，与标准血压目标相比，更严格的血压目标并未明显降低原发性心血管结局或大多数继发性心血管结局的发生率。在这项研究中，虽然临床获益有限（5 年预防一次卒中的需治人数 [NNT] = 89），但是强化治疗组内总的卒中发生数和非致命性卒中发生数均降低。[68]ACCORD Study Group; Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010 Apr 29;362(17):1575-85.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123215/http://www.ncbi.nlm.nih.gov/pubmed/20228401?tool=bestpractice.com
在糖尿病患者中，某些研究已证明，睡眠时血压下降（这是一个新的治疗目标，需要通过动态监测进行评估）是无事件生存率最重要的独立预测因子。[135]Hermida RC, Ayala DE, Mojón A, et al. Sleep-time blood pressure as a therapeutic target for cardiovascular risk reduction in type 2 diabetes. Am J Hypertens. 2012 Mar;25(3):325-34.http://www.ncbi.nlm.nih.gov/pubmed/22158066?tool=bestpractice.com[136]Hermida RC, Ayala DE, Mojón A, et al. Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD. J Am Soc Nephrol. 2011 Dec;22(12):2313-21.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3279936/http://www.ncbi.nlm.nih.gov/pubmed/22025630?tool=bestpractice.com[137]Hermida RC, Ayala DE, Mojón A, et al. Decreasing sleep-time blood pressure determined by ambulatory monitoring reduces cardiovascular risk. J Am Coll Cardiol. 2011 Sep 6;58(11):1165-73.http://www.ncbi.nlm.nih.gov/pubmed/21884956?tool=bestpractice.com[138]Hermida RC, Ayala DE, Mojón A, et al. Chronotherapy with valsartan/hydrochlorothiazide combination in essential hypertension: improved sleep-time blood pressure control with bedtime dosing. Chronobiol Int. 2011 Aug;28(7):601-10.http://www.ncbi.nlm.nih.gov/pubmed/21823969?tool=bestpractice.com[139]Hermida RC, Ayala DE, Mojón A, et al. Influence of time of day of blood pressure-lowering treatment on cardiovascular risk in hypertensive patients with type 2 diabetes. Diabetes Care. 2011 Jun;34(6):1270-6.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114338/http://www.ncbi.nlm.nih.gov/pubmed/21617110?tool=bestpractice.com
