高血壓與2型糖尿病（T2DM）均為心血管和腎臟疾病重要的危險因素，且共患率高。T2DM患者的高血壓篩查、監測、管理等問題對改善患者預后具有重要作用。基于此背景，中華醫學會糖尿病學分會糖尿病與肥胖學組和中國高血壓聯盟組織多學科專家制訂該共識，共識通過在線調查和討論，經文獻檢索、證據總結和專家評議，基于GRADE方法及GRADE證據向決策（EtD）轉化框架，遴選出7個關鍵臨床問題，并給出12條推薦意見。推薦內容涵蓋了未診斷高血壓的T2DM患者進行高血壓篩查的方式和頻率，已診斷高血壓的T2DM患者的血壓監測方式和頻率、血壓控制目標、生活方式管理以及藥物使用建議等。該共識可供從事T2DM及高血壓診療的內分泌代謝病專科、心血管病專科及全科醫師參考，旨在提升我國T2DM患者高血壓篩查、監測和治療的整體管理能力，從而降低因高血壓帶來的心血管和腎臟疾病相關致死和致殘風險，并減輕T2DM患者的治療負擔。
Citation： Diabetes and Obesity Research Group of Chinese Diabetes Society (CDS), Chinese Hypertension League (CHL). Chinese expert consensus on the management of hypertension in adults with type 2 diabetes. Chinese Journal of Evidence-Based Medicine, 2025, 25(6): 621-632. doi: 10.7507/1672-2531.202504150 Copy
Copyright ? the editorial department of Chinese Journal of Evidence-Based Medicine of West China Medical Publisher. All rights reserved
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| 44. | Kwakernaak AJ, Krikken JA, Binnenmars SH, et al. Effects of sodium restriction and hydrochlorothiazide on RAAS blockade efficacy in diabetic nephropathy: a randomised clinical trial. Lancet Diabetes Endocrinol, 2014, 2(5): 385-395. |
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- 1. Jia G, Sowers JR. Hypertension in diabetes: an update of basic mechanisms and clinical disease. Hypertension, 2021, 78(5): 1197-1205.
- 2. Li Y, Teng D, Shi X, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study. BMJ, 2020, 369: m997.
- 3. Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
- 4. Li S, Zong Z, Sun X, et al. New evidence-based clinical practice guideline timely supports hospital infection control of coronavirus disease 2019. Precis Clin Med, 2020, 3(1): 1-2.
- 5. Zhou YL, Zhang YG, Zhang R, et al. Population diversity of cardiovascular outcome trials and real-world patients with diabetes in a Chinese tertiary hospital. Chin Med J, 2021, 134(11): 1317-1323.
- 6. Lindbohm JV, Sipil? PN, Mars NJ, et al. 5-year versus risk-category-specific screening intervals for cardiovascular disease prevention: a cohort study. Lancet Public Health, 2019, 4(4): e189-e199.
- 7. Moberg J, Oxman AD, Rosenbaum S, et al. The GRADE evidence to decision (EtD) framework for health system and public health decisions. Health Res Policy Syst, 2018, 16(1): 45.
- 8. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
- 9. Liu W, Wang W, Sun F, et al. Machine learning-assisted analysis of sublingual microcirculatory dysfunction for early cardiovascular risk evaluation and cardiovascular-kidney-metabolic syndrome stage in patients with type 2 diabetes mellitus. Diabetes Metab Res Rev, 2024, 40(6): e3835.
- 10. Guirguis-Blake JM, Evans CV, Webber EM, et al. Screening for hypertension in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 2021, 325(16): 1657-1669.
- 11. Chen S, Sudharsanan N, Huang F, et al. Impact of community based screening for hypertension on blood pressure after two years: regression discontinuity analysis in a national cohort of older adults in China. BMJ, 2019, 366: l4064.
- 12. Cohen JB, Lotito MJ, Trivedi UK, et al. Cardiovascular events and mortality in white coat hypertension: a systematic review and meta-analysis. Ann Intern Med, 2019, 170(12): 853-862.
- 13. Takeno K, Mita T, Nakayama S, et al. Masked hypertension, endothelial dysfunction, and arterial stiffness in type 2 diabetes mellitus: a pilot study. Am J Hypertens, 2012, 25(2): 165-170.
- 14. Lu J, Lu Y, Wang X, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1. 7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet, 2017, 390(10112): 2549-2558.
- 15. Karnjanapiboonwong A, Anothaisintawee T, Chaikledkaew U, et al. Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta-analysis. BMC Cardiovasc Disord, 2020, 20(1): 491.
- 16. Piper MA, Evans CV, Burda BU, et al. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U. S. Preventive Services Task Force. Ann Intern Med, 2015, 162(3): 192-204.
- 17. Kario K, Shimbo D, Tomitani N, et al. The first study comparing a wearable watch-type blood pressure monitor with a conventional ambulatory blood pressure monitor on in-office and out-of-office settings. J Clin Hypertens (Greenwich), 2020, 22(2): 135-141.
- 18. Jones NR, McCormack T, Constanti M, et al. Diagnosis and management of hypertension in adults: NICE guideline update 2019. Br J Gen Pract, 2020, 70(691): 90-91.
- 19. 中國心臟聯盟心血管疾病預防與康復專業委員會. 高血壓患者血壓季節性變化臨床管理中國專家共識. 中華高血壓雜志, 2022, 30(9): 813-817.
- 20. Al-Makki A, DiPette D, Whelton PK, et al. Hypertension pharmacological treatment in adults: a World Health Organization guideline executive summary. Hypertension, 2022, 79(1): 293-301.
- 21. Sheppard JP, Tucker KL, Davison WJ, et al. Self-monitoring of blood pressure in patients with hypertension-related multi-morbidity: systematic review and individual patient data meta-analysis. Am J Hypertens, 2020, 33(3): 243-251.
- 22. Omboni S, Gazzola T, Carabelli G, et al. Clinical usefulness and cost effectiveness of home blood pressure telemonitoring: meta-analysis of randomized controlled studies. J Hypertens, 2013, 31(3): 455-467.
- 23. McManus RJ, Mant J, Franssen M, et al. Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial. Lancet, 2018, 391(10124): 949-959.
- 24. Niiranen TJ, Kantola IM, Vesalainen R, et al. A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment. Am J Hypertens, 2006, 19(5): 468-474.
- 25. Nasothimiou EG, Karpettas N, Dafni MG, et al. Patients' preference for ambulatory versus home blood pressure monitoring. J Hum Hypertens, 2014, 28(4): 224-229.
- 26. Turchin A, Goldberg SI, Shubina M, et al. Encounter frequency and blood pressure in hypertensive patients with diabetes mellitus. Hypertension, 2010, 56(1): 68-74.
- 27. Tucker KL, Sheppard JP, Stevens R, et al. Self-monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis. PLoS Med, 2017, 14(9): e1002389.
- 28. Verberk WJ, Kroon AA, Lenders JW, et al. Self-measurement of blood pressure at home reduces the need for antihypertensive drugs: a randomized, controlled trial. Hypertension, 2007, 50(6): 1019-1025.
- 29. Staessen JA, Den Hond E, Celis H, et al. Antihypertensive treatment based on blood pressure measurement at home or in the physician's office: a randomized controlled trial. JAMA, 2004, 291(8): 955-964.
- 30. 中國高血壓防治指南修訂委員會, 高血壓聯盟, 中華醫學會心血管病學分會中國醫師協會高血壓專業委員會, 等. 中國高血壓防治指南(2018年修訂版). 中國心血管雜志, 2019, 24(1): 24-56.
- 31. Emdin CA, Rahimi K, Neal B, et al. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA, 2015, 313(6): 603-615.
- 32. Wang J, Chen Y, Xu W, et al. Effects of intensive blood pressure lowering on mortality and cardiovascular and renal outcomes in type 2 diabetic patients: a meta-analysis. PLoS One, 2019, 14(4): e0215362.
- 33. Liu J, Li Y, Ge J, et al. Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial. Lancet, 2024, 404(10449): 245-255.
- 34. Wu Z, Jin C, Vaidya A, et al. Longitudinal patterns of blood pressure, incident cardiovascular events, and all-cause mortality in normotensive diabetic people. Hypertension, 2016, 68(1): 71-77.
- 35. Bangalore S, Messerli FH, Wun CC, et al. J-curve revisited: an analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) trial. Eur Heart J, 2010, 31(23): 2897-2908.
- 36. Messerli FH, Mancia G, Conti CR, et al. Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous. Ann Intern Med, 2006, 144(12): 884-893.
- 37. Arguedas JA, Leiva V, Wright JM. Blood pressure targets for hypertension in people with diabetes mellitus. Cochrane Database Syst Rev, 2013, 2013(10): CD008277.
- 38. Saiz LC, Gorricho J, Garjón J, et al. Blood pressure targets for the treatment of people with hypertension and cardiovascular disease. Cochrane Database Syst Rev, 2022, 11(11): CD010315.
- 39. Aburto NJ, Ziolkovska A, Hooper L, et al. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ, 2013, 346: f1326.
- 40. Hu G, Jousilahti P, Peltonen M, et al. Urinary sodium and potassium excretion and the risk of type 2 diabetes: a prospective study in Finland. Diabetologia, 2005, 48(8): 1477-1483.
- 41. Ming L, Wang D, Zhu Y. Association of sodium intake with diabetes in adults without hypertension: evidence from the National Health and Nutrition Examination Survey 2009-2018. Front Public Health, 2023, 11: 1118364.
- 42. Horikawa C, Yoshimura Y, Kamada C, et al. Dietary sodium intake and incidence of diabetes complications in Japanese patients with type 2 diabetes: analysis of the Japan Diabetes Complications Study (JDCS). J Clin Endocrinol Metab, 2014, 99(10): 3635-3643.
- 43. Hodson EM, Cooper TE. Altered dietary salt intake for preventing diabetic kidney disease and its progression. Cochrane Database Syst Rev, 2023, (1): CD006763.
- 44. Kwakernaak AJ, Krikken JA, Binnenmars SH, et al. Effects of sodium restriction and hydrochlorothiazide on RAAS blockade efficacy in diabetic nephropathy: a randomised clinical trial. Lancet Diabetes Endocrinol, 2014, 2(5): 385-395.
- 45. Kaczorowski J, Chambers LW, Dolovich L, et al. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP). BMJ, 2011, 342: d442.
- 46. Xia T, Zhao F, Nianogo RA. Interventions in hypertension: systematic review and meta-analysis of natural and quasi-experiments. Clin Hypertens, 2022, 28(1): 13.
- 47. Yuan Y, Jin A, Neal B, et al. Salt substitution and salt-supply restriction for lowering blood pressure in elderly care facilities: a cluster-randomized trial. Nat Med, 2023, 29(4): 973-981.
- 48. Zhang X, Yuan Y, Li C, et al. Effect of a salt substitute on incidence of hypertension and hypotension among normotensive adults. J Am Coll Cardiol, 2024, 83(7): 711-722.
- 49. Neal B, Wu Y, Feng X, et al. Effect of salt substitution on cardiovascular events and death. N Engl J Med, 2021, 385(12): 1067-1077.
- 50. Aburto NJ, Hanson S, Gutierrez H, et al. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ, 2013, 346: f1378.
- 51. Cheng J, Zhang W, Zhang X, et al. Effect of angiotensin-converting enzyme inhibitors and angiotensin Ⅱ receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: a meta-analysis. JAMA Intern Med, 2014, 174(5): 773-785.
- 52. Lv J, Perkovic V, Foote CV, et al. Antihypertensive agents for preventing diabetic kidney disease. Cochrane Database Syst Rev, 2012, (12): CD004136.
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