Se zvyšujícím se počtem diabetiků v populaci dochází také ke zvýšení mikrovaskulárních a makrovaskulárních komplikací. Poškození ledvin představuje jednu z hlavních příčin mortality u pacientů s diabetem. Klasifikace diabetické nefropatie je založena na hodnotě glomerulární filtrace a stupni albuminurie a rozděluje pacienty do tříd podle mortalitního rizika. Léčba pacientů je založena na datech z velkých multicentrických studií, které prokázaly kardiovaskulární benefit zejména při používání gliflozinů. Proto glifloziny a statiny společně s metforminem patří mezi léky první volby u pacientů s diabetem mellitem 2. typu a renálním postižením. Komplexní péče o tyto nemocné by současně měla zahrnovat pravidelné dieto- logické konzultace, fyzickou aktivitu a psychologickou podporu. Odlišná situace je zatím u pacientů s diabetem mellitem 1. typu. Glifloziny se u těchto nemocných nedoporučují používat. Zde základem farmakoterapie zůstávají ACEi nebo sar- tany a současně dostatečná kompenzace diabetu. V pokročilých stadiích je důležité odesílat pacienty včas ke specialistům k posouzení transplantační léčby.
With the increasing number of diabetics in the population, there is also a rise in both microvascular and macrovascular complications. Kidney damage represents one of the leading causes of mortality in patients with diabetes. The classification of diabetic nephropathy is based on the glomerular filtration rate and the degree of albuminuria, categorizing patients into risk groups according to their mortality risk. The treatment of these patients is based on data from large multicenter studies, which have demonstrated cardiovascular benefits, particularly with the use of gliflozins. Therefore, gliflozins and statins, together with metformin, are among the first-line treatment options for patients with type 2 diabetes mellitus and renal impairment. Comprehensive care for these patients should also include regular dietary consultations, physical activity, and psychological support. The situation is different for patients with type 1 diabetes mellitus, where the use of gliflozins is not recommended. In this group, the cornerstone of pharmacotherapy remains ACE inhibitors or sartans, along with adequate diabetes management. In advanced stages of the disease, it is crucial to refer patients to specialists in a timely manner for the evaluation of transplantation therapy.
- MeSH
- Angiotensin II Type 1 Receptor Blockers administration & dosage pharmacology therapeutic use MeSH
- Diabetes Mellitus * diagnosis therapy MeSH
- Diabetic Nephropathies diagnosis drug therapy prevention & control MeSH
- Sodium-Glucose Transporter 2 Inhibitors administration & dosage pharmacology therapeutic use MeSH
- Diabetes Complications prevention & control therapy MeSH
- Humans MeSH
- Kidney Transplantation MeSH
- Pancreas Transplantation MeSH
- Check Tag
- Humans MeSH
- MeSH
- Medication Adherence MeSH
- Antihypertensive Agents administration & dosage therapeutic use MeSH
- Calcium Channel Blockers administration & dosage pharmacology therapeutic use MeSH
- Angiotensin II Type 1 Receptor Blockers administration & dosage pharmacology therapeutic use MeSH
- Drug Combinations MeSH
- Hypertension * diagnosis drug therapy prevention & control MeSH
- Angiotensin-Converting Enzyme Inhibitors administration & dosage pharmacology therapeutic use MeSH
- Humans MeSH
- Secondary Prevention MeSH
- Check Tag
- Humans MeSH
Výskyt arteriální hypertenze je u diabetiků 2. typu dvakrát častější než v běžné populaci a stoupá v závislosti na věku a délce trvání diabetu. Dobrá kontrola hypertenze u diabetiků je zásadní pro snížení kardiovaskulárního rizika a také mikrovaskulárních komplikací. Základem léčby hypertenze u diabetiků je blokáda renin-angiotenzin-aldosteronového systému. V současných postupech se doporučuje preference kombinační antihypertenzní léčby a snaha o rychlou normalizaci krevního tlaku. Nová antidiabetika (inhibitory sodíko-glukózového kotransportéru 2 [sodium-glucose co-transporter 2, SGLT2] a agonisté glukagonu podobného peptidu 1 [glucagon-like peptide-1, GLP-1]) mají nezanedbatelný antihypertenzní účinek a představují novou příležitost k optimalizaci současné léčby hypertenze u diabetických pacientů. Agonisté GLP-1 mají i významný vliv na redukci tělesné hmotnosti. Tento článek shrnuje současné poznatky a doporučení v léčbě hypertenze u obézních diabetiků 2. typu.
The incidence of arterial hypertension is twice as common in type 2 diabetics as in the general population and increases with age and duration of diabetes. Good control of hypertension in diabetics is essential to reduce cardiovascular risk as well as microvascular complications. The basis of the treatment of hypertension in diabetics is the blockade of the renin-angiotensin-aldosterone system. In current procedures, preference for combination antihypertensive therapy and efforts to rapidly normalize blood pressure are recommended. The new antidiabetics (sodium-glucose co-transporter 2 [SGLT2] inhibitors and glucagon-like peptide-1 [GLP-1] agonists) have a significant antihypertensive effect and represent a new opportunity to optimize the current treatment of hypertension in diabetic patients. Glucagon-like peptide-1 agonists also have a significant effect on reducing body weight. This article summarizes current knowledge and recommendations in the treatment of hypertension in obese type 2 diabetics.
- MeSH
- Antihypertensive Agents pharmacology classification therapeutic use MeSH
- Bariatric Surgery methods MeSH
- Angiotensin II Type 1 Receptor Blockers pharmacology classification therapeutic use MeSH
- Diabetes Mellitus, Type 2 * diagnosis drug therapy MeSH
- Sodium-Glucose Transporter 2 Inhibitors pharmacology therapeutic use MeSH
- Hypertension * diagnosis etiology drug therapy MeSH
- Angiotensin-Converting Enzyme Inhibitors pharmacology classification therapeutic use MeSH
- Humans MeSH
- Obesity diagnosis drug therapy MeSH
- Glucagon-Like Peptide-1 Receptor therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Antihypertensive Agents pharmacology therapeutic use MeSH
- Angiotensin II Type 1 Receptor Blockers * pharmacology therapeutic use MeSH
- Drug Combinations MeSH
- Hypertension drug therapy MeSH
- Angiotensin-Converting Enzyme Inhibitors * pharmacology therapeutic use MeSH
- Drug Therapy, Combination MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Antihypertensive Agents therapeutic use MeSH
- Calcium Channel Blockers therapeutic use MeSH
- Angiotensin II Type 1 Receptor Blockers therapeutic use MeSH
- Diabetes Mellitus * drug therapy MeSH
- Drug Combinations MeSH
- Hypertension * drug therapy complications physiopathology MeSH
- Hypoglycemic Agents therapeutic use MeSH
- Comorbidity MeSH
- Diabetes Complications MeSH
- Blood Pressure MeSH
- Humans MeSH
- Renin-Angiotensin System MeSH
- Heart Disease Risk Factors MeSH
- Check Tag
- Humans MeSH
- MeSH
- Mineralocorticoid Receptor Antagonists pharmacology adverse effects therapeutic use MeSH
- Adrenergic beta-Antagonists pharmacology adverse effects therapeutic use MeSH
- Angiotensin II Type 1 Receptor Blockers pharmacology adverse effects therapeutic use MeSH
- Digoxin pharmacology adverse effects therapeutic use MeSH
- Sodium-Glucose Transporter 2 Inhibitors pharmacology adverse effects therapeutic use MeSH
- Angiotensin-Converting Enzyme Inhibitors pharmacology adverse effects therapeutic use MeSH
- Humans MeSH
- Neprilysin antagonists & inhibitors MeSH
- Heart Failure * drug therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Angiotensin II Type 1 Receptor Blockers * administration & dosage pharmacology therapeutic use MeSH
- Hypertension * drug therapy pathology MeSH
- Angiotensin-Converting Enzyme Inhibitors adverse effects therapeutic use MeSH
- Humans MeSH
- Drug-Related Side Effects and Adverse Reactions MeSH
- Randomized Controlled Trials as Topic MeSH
- Heart Failure drug therapy MeSH
- Check Tag
- Humans MeSH
- MeSH
- Medication Adherence MeSH
- Angiotensin II Type 1 Receptor Blockers * pharmacology therapeutic use MeSH
- Hypertension drug therapy MeSH
- Angiotensin-Converting Enzyme Inhibitors therapeutic use MeSH
- Cardiovascular Diseases drug therapy prevention & control MeSH
- Congresses as Topic MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Keywords
- sakubitril/valsartan,
- MeSH
- Ambulatory Care MeSH
- Aminobutyrates administration & dosage therapeutic use MeSH
- Biphenyl Compounds therapeutic use MeSH
- Angiotensin II Type 1 Receptor Blockers administration & dosage pharmacology therapeutic use MeSH
- Drug Combinations MeSH
- Clinical Studies as Topic MeSH
- Humans MeSH
- Heart Failure * diagnosis drug therapy physiopathology MeSH
- Valsartan administration & dosage pharmacology therapeutic use MeSH
- Insurance, Health MeSH
- Check Tag
- Humans MeSH
- Publication type
- Newspaper Article MeSH
- Keywords
- sacubitril-valsartan, studie PARAMOUNT, studie PROVE, studie EVALUATE, studie PARADIGM-HF, Studie TRANSITION, studie PIONEER-HF, studie LIFE, studie PARADISE MI,
- MeSH
- Angiotensin II Type 1 Receptor Blockers * MeSH
- Drug Combinations MeSH
- Clinical Trials as Topic statistics & numerical data MeSH
- Humans MeSH
- Mortality MeSH
- Natriuretic Peptides metabolism therapeutic use MeSH
- Neprilysin * antagonists & inhibitors MeSH
- Heart Failure drug therapy classification MeSH
- Valsartan * pharmacology therapeutic use MeSH
- Check Tag
- Humans MeSH
