首先,这是我在世界心脏病大会上所讨论的一个问题。我对ESH和ESC发布的2013版指南持支持态度。新指南认为将心血管事件高危患者的血压降至130/80 mm Hg以下缺乏前瞻性试验数据的支持,故推荐上述患者的血压控制目标为将收缩压降至140 mm Hg以下,如果患者年龄≥80岁则其收缩压控制在140~150 mm Hg即可。
<International Circulation>: Your articles share your experience about these antihypertensive therapies for the elderly patients. Could you talk a little bit about this issue and how you can try to improve your patients’ clinical outcome?
Prof. Aronow: Well, the most important thing is to support those guidelines. You do not want to leave the blood pressure untreated, it is extremely important that you do not want to go too low.
《国际循环》:您曾撰文分享了老年高血压患者降压治疗的经验。您能否简述一下该话题,应如何改善老年患者的临床结局?
Aronow教授:最重要的就是根据指南进行相关治疗,不能不对患者进行治疗也不能将血压降得过低。
<International Circulation>: One more question is dealing with type 2 diabetes. You have discussed comprehensive management of type 2 diabetes which includes the management of blood glucose, blood management, and lipid in an editorial article. Can you give just a brief introduction, according to the ADA 2013 guidelines about how to best implement a comprehensive management for these type 2 diabetics and specifically what is the exact control target that you are looking for with these indicators?
Prof. Aronow: What I am looking for in terms of hemoglobin A1c, I’m looking for a hemoglobin A1c ideally in the younger patients of less than 7.0%. In patients who are elderly and many with long standing diabetes, cardiovascular disease, and comorbidities, I would go to 7.5%. In terms of blood pressure, the blood pressure should be lowered to less than 130 and less than 90. Systolic blood pressure should be between 130 and 139 mm Hg but not lower than that. In terms of lipids, diabetics should have their serum LDL cholesterol reduced to less than 70 mg/dl. Statins are the drug of choice. I would not use in these patients or add to a statin either nicotinic acid based on recent trials, or fibric acid derivatives based on recent trials.
《国际循环》:就2型糖尿病患者而言,您曾在一篇社论中就2型糖尿病血压、血糖、血脂控制等综合管理问题进行了探讨。您能否简要介绍一下,根据ADA 2013版最新指南我们应如何对2型糖尿病患者更好地实施综合管理?其各项指标的最佳控制目标是多少?
Aronow教授:就糖化血红蛋白HbA1c而言,年轻患者的理想控制目标是<7.0%;老年、病程较长、合并心血管疾病或其他合并症的患者的控制目标为<7.5%。就血压而言,理想的降压目标值为130/90 mm Hg。其中收缩压应降至130~139 mm Hg,但不应低于130 mm Hg。就血脂而言,糖尿病患者的血清LDL-C应降至70 mg/dl以下。他汀类药物是首选降脂药。根据近期临床试验结果,在糖尿病患者中我一般不会单用或与他汀类药物联用烟酸及纤维酸衍生物。