The HOPE study and diabetes

微量白蛋白尿 雷米普利 医学 糖尿病 肾病 疾病 内科学 2型糖尿病 2型糖尿病 蛋白尿 内分泌学 血压
作者
Tonny Jensen
出处
期刊:The Lancet [Elsevier BV]
卷期号:355 (9210): 1181-1181 被引量:5
标识
DOI:10.1016/s0140-6736(00)02076-6
摘要

The Heart Outcomes Prevention Evaluation (HOPE) Study Investigators (Jan 22, p 253)1Heart Outcomes Prevention Evaluation (HOPE) Study InvestigatorsEffects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy.Lancet. 2000; 355: 253-259Summary Full Text Full Text PDF PubMed Scopus (3298) Google Scholar report that ramipril given to people with diabetes mellitus lowered the risk of major cardiovascular outcomes by 25–30%. They claim that the effect was apparent irrespective of whether participants had a history of cardiovascular events, hypertension, or microalbuminuria, were taking insulin or oral hypoglycaemic agents, or had type-1 or type-2 diabetes mellitus. The investigators also state that ramipril lowered the risk of overt nephropathy, renal failure, or laser therapy, and that it had no long-term effect on glycaemic control. Although these results are interesting, several critical points can be raised, and it can also be argued that the new information given in the paper is limited. Figure 2 shows that the relative risk reduction in subgroups without microalbuminuria, with no cardiovascular disease and with type-1 diabetes do not reach significance despite high numbers of patients: without microalbuminuria (n=2437) and with no cardiovascular disease (n=1119). Since more than 98% of the patients had type-2 diabetes mellitus it is obvious that no conclusions of the effect of ramipril in type-1 diabetes mellitus can be drawn from the study. Thus, only in patients with diabetes with microalbuminuria or cardiovascular disease, or both, at high risk of having cardiovascular events, is the relative risk reduction significant. No data on metabolic control and blood pressure as absolute figures are given in the paper. We are only told that blood pressure and glycated haemoglobin (HbA1c) are significantly lower in the ramipril group, but for HbA1c the difference is not shown. Thus, it can be argued that the findings in this study only confirm what has been shown in the UK Prospective Diabetes Study.2UK Prospective Diabetes Study (UKPDS) GroupEfficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39.BMJ. 1998; 317: 713-720Crossref PubMed Google Scholar In the conclusion the investigators claim that ramipril lowered the risk of nephropathy, renal failure, or laser therapy. Ramipril does indeed reduce the risk of developing nephropathy in patients with microalbuminuria, as previous studies have shown.3Ravid M Lang R Rachmani R Lishner M Long-term renoprotective effect of angiotensin-converting enzyme inhibition in non-insulin-dependent diabetes mellitus: a 7 year follow-up study.Arch Intern Med. 1996; 156: 286-289Crossref PubMed Scopus (0) Google Scholar However, table 3 shows that there was no effect on laser therapy (p=0·70) nor dialysis (p=0·70) in the ramipril group. The results of the HOPE study in patients with diabetes mellitus are important but mostly because they confirm previous studies. The study underlines the importance of strict metabolic control and aggressive antihypertensive treatment in high-risk patients with type-2 diabetes who have cardiovascular disease or microalbuminuria. However, it is not shown that patients with uncomplicated type-2 diabetes, with only one additional risk factor, will benefit from angiotensin-convertingenzyme (ACE) inhibitor treatment. Nor is it shown that there are new effects of ACE-inhibitors on end-stage manifestations of diabetic nephropathy or proliferative retinopathy. The HOPE study and diabetesAuthors' reply Full-Text PDF
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
刚刚
我要文献发布了新的文献求助10
1秒前
1秒前
1秒前
量子星尘发布了新的文献求助10
4秒前
暴躁小龙发布了新的文献求助10
5秒前
张润泽完成签到 ,获得积分10
5秒前
6秒前
文档发布了新的文献求助10
6秒前
7秒前
9秒前
10秒前
10秒前
11秒前
12秒前
12秒前
烟花应助zwk采纳,获得10
14秒前
蔡芝艳关注了科研通微信公众号
14秒前
YI完成签到,获得积分10
17秒前
17秒前
大个应助科研通管家采纳,获得10
18秒前
18秒前
充电宝应助科研通管家采纳,获得10
19秒前
SYLH应助科研通管家采纳,获得20
19秒前
Ava应助科研通管家采纳,获得10
19秒前
丘比特应助科研通管家采纳,获得10
19秒前
情怀应助科研通管家采纳,获得10
19秒前
Hello应助科研通管家采纳,获得10
19秒前
Owen应助科研通管家采纳,获得10
19秒前
19秒前
su发布了新的文献求助10
21秒前
钟垠州完成签到 ,获得积分10
21秒前
21秒前
活力的妙之完成签到 ,获得积分10
21秒前
丘比特应助只想困瞌睡采纳,获得10
21秒前
小宋发布了新的文献求助10
22秒前
笃定发布了新的文献求助30
24秒前
淡墨完成签到,获得积分10
25秒前
今后应助清漪采纳,获得10
25秒前
zwk发布了新的文献求助10
26秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3989297
求助须知:如何正确求助?哪些是违规求助? 3531418
关于积分的说明 11253893
捐赠科研通 3270097
什么是DOI,文献DOI怎么找? 1804884
邀请新用户注册赠送积分活动 882087
科研通“疑难数据库(出版商)”最低求助积分说明 809158