Expert consensus on blood pressure management of diabetic patients in China (中国糖尿病患者血压管理专家共识)

This Expert Consensus proposed by the Chinese Society of Endocrinology (CSE) updates concepts on hypertension management in patients with diabetes. It focuses on clinical outcomes literature published within the past 5 years and currently in press, and incorporates these new observations into modifications of established guidelines. Complications and mortality in diabetic patients are increased when hypertension is present. The present update focuses on questions such as what to do when a diabetic patient has an elevated blood pressure level when therapy is initiated and whether combinations of agents should be used as soon as possible. Although the strategies and principles of treatment remain unchanged, approaches to specific patient-related issues influencing cardiovascular outcomes in people with diabetes have changed. Finally, an updated integrated management of multiple cardiovascular risk factors is provided and is suggested as a starting point to achieve blood pressure goals. In addition to controlling blood pressure, the CSE suggests that individualized strategies are equally important and that attention should be paid to other factors, including safety (which is the most important), feasibility, and health economic evaluation. 摘要 本专家共识由中华医学会内分泌学分会组织专家编写并修订，更新了对糖尿病患者的高血压管理的一些概念。本期发表的新版专家共识主要关注于近５年发表的临床研究结果，在修订指南时将这些新的发现整合入其中。糖尿病存在高血压时可提高并发症发生率和死亡率。本版更新的专家共识着重专注诸如糖尿病患者血压升高时应该做些什么，何时开始治疗，是否尽快实施联合治疗方案等问题。虽然治疗的策略和原则并未改变，但是修改了治疗策略中可能影响特殊糖尿病患者人群心血管结局的相关治疗路径。最后，共识提出了对糖尿病患者的多重心血管危险因素的综合管理，并建议将其作为血压管理达标的基点。另外，除了规范控制糖尿病患者的血压达标，中华医学会内分泌学分会强调实施糖尿病患者血压个体化管理策略同等重要，应当积极科学地评价影响血压规范管理的其他因素，包括药物的安全性（最为重要）、可行性和卫生经济学等。