徳島高血圧・糖尿病study : 高血圧・糖尿病合併例に関する臨床的検討

Hypertension is frequently complicated by diabetes mellitus and vice versa. Since
these ２ disorders are important risk factors for atherosclerotic cardiovascular diseases, appropriate disease control is required. To understand the present state of treatment, we investigated hypertensive patients complicated by diabetes mellitus and vice versa who were under treatment by cardiology and diabetes specialists in Tokushima Prefecture, and evaluated the details of treatment and the state of disease control.
The subjects consisted of １８２ hypertensive patients complicated by diabetes mellitus （Group C） who were under treatment by cardiology specialists and ２０５ diabetic patients complicated by hypertension （Group D） who were under treatment by diabetes specialists. When patient backgrounds were evaluated, patient age and BMI were significantly higher in Group C than in Group D, although HbA１c levels were significantly higher in Group D than in Group C. Calcium antagonists were most frequently used for the treatment of hypertension in both groups （７０．９％ in Group C and ６５．４％ in Group D）, and the percentage of patients who were treated with β‐blockers was significantly higher in Group C than in Group D （２８．６％ in Group C vs.８．８％ in Group D, p＜０．０００５）. The percentage of patients who fulfilled the criteria of blood pressure recommended by the Guidelines for the Management of Hypertension （JSH２０００） was ２１．６％ in Group C and ２２．９％ in Group D. When the type of antidiabetics was investigated, SU derivatives were most frequently used for the treatment of diabetes mellitus in both groups （４７．２％ in Group C and ５０．２％ in Group D, n.s.）, followed by the use of α‐GI, insulin, and biguanide in descending order. The percentage of patients who were treated with those types of antidiabetics did not significantly differ between the two groups. The percentage of patients who showed HbA１c levels below ６．５％ was significantly higher in Group C than in Group D （４０．７％ in Group C vs．２１．９％ in Group D p＜０．００５）. However, the percentage of patients who showed HbA１c levels of ８．０％ or higher was significantly higher in Group D than in Group C （１８．９％ in Group C vs. ３６．８％ in Group D, p＜０．０００１）. In addition, the percentage of patients in whom total cholesterol levels were successfully controlled based on the Guidelines for Diagnosis and Treatment of Atherosclerotic Cardiovascular Diseases （JAS２００２） did not significantly differ between the two groups （４９．７％ in Group C vs. ４５．０％ in Group D）. These findings suggest that the group at high-risk of atherosclerosis, such as hypertensive patients complicated by diabetes mellitus and vice versa, is not successfully managed. Therefore, more appropriate disease control is required in the future.

四国医学雑誌 : http://www.tokushima-u.ac.jp/med/research/shikoku_acta_medica.html