@article{oai:niigata-u.repo.nii.ac.jp:00009862,
 author = {竹田, 徹朗},
 issue = {12},
 journal = {新潟医学会雑誌, 新潟医学会雑誌},
 month = {Dec},
 note = {Hypertension and diabetes mellitus are closely associated diseases which are both strongly related to the risk of cardiovascular disease. Major guidelines suggested that the goal blood pressure in patients with diabetes mellitus is less than 130/80 mmHg. An ACE inhibitor or Angiotensin II receptor blocker (ARB) is clearly preferred as initial therapy in any hypertensive diabetic patient in an attempt to slow renal disease progression. Monotherapy can attain goal blood pressure in some patients with diabetes and hypertension. This is most likely to occur in those with blood pressures that are only modestly above goal. However, combination therapy is eventually required in most patients. There is still some controversy about whether calcium channel blocker or low-dose hydrochlorothiazide provide better protection against cardiovascular events when both are used in combination with an ACE inhibitor or ARB. Other antihypertensive drugs can be added if the blood pressure goal is still not achieved. Aliskiren is the first member of the new class of orally active direct renin inhibitors which may also be a promising renoprotective strategy in patients with concomitant hypertension and diabetes mellitus., 高血圧と糖尿病の治療ゴールはともに心血管病 (Cardiovascular disease, CVD) の回避と抑制である. ともにインスリン抵抗性が病因となることが多く, 互いに併存する率も高い. 糖尿病に伴うCVDは重篤・難治であるため, 一次予防が重要である. 大規模疫学研究の結果により血圧管理目標は, 高血圧単独よりも厳格となっており, 日本高血圧学会ガイドラインであるJSH2009 では目標血圧は130/80mmHgである. 糖尿病合併高血圧での降圧薬の第一選択はアンジオテンシン変換酵素 (ACE) 阻害薬またはアンジオテンシンII受容体ブロッカー (ARB) である. 治療抵抗例も多く, 厳格な降圧目標達成には多剤併用が現実的である. その際の第二選択薬としてカルシウム拮抗薬か利尿薬のどちらが有用かは研究途上である. 最近になってレニン・アンジオテンシン (RAS) 系阻害薬に新しい作用機序の直接的レニン阻害薬が臨床応用されるようになり, 今後その有用性が検討されよう.},
 pages = {659--662},
 title = {4 新しい降圧薬の使い方(糖尿病の診断と治療の急速な展開,第661回新潟医学会)},
 volume = {125},
 year = {2011}
}