بررسی تغییرات فشار خون و نبض بین گروه های دارویی درمانی دیابت در بیماران دیابت تیپ 2

بررسی تغییرات فشار خون و نبض بین گروه های دارویی درمانی دیابت در بیماران دیابت تیپ 2

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دیابت به تنهایی به عنوان یک فاکتور خطر بیماری قلبی-عروقی مد نظر می باشد. در بیمارانی که علاوه بر دیابت، مبتلا به فشار نبض بالا نیز می باشند شانس بیماری قلبی-عروقی و مرگ و میر متعاقب آن افزایش می یابد. اگرچه تا به حال مطالعاتی برای بررسی و مقایسه اثر رژیم ها مختلف مورد استفاده در دیابت بر روی فشار خون و فشار نبض انجام شده است، مطالعه ای جامع برای مقایسه این اثر میان رژیم های دارویی رایج کنترل قند خون وجود ندارد.
هدف از اجرا: در این مطالعه بر آن شدیم تا تاثیر گروه های درمانی مختلف رایج دیابت را بر روی فشار نبض و فشار خون بیماران دیابت تیپ 2 بررسی کنیم.
روش انجام: در یک مطالعه مقطعی، پرونده 718 بیمار دیابت تیپ 2 بدون سابقه فشار خون انتخاب شدند و بر اساس گروه های درمانی رایج تقسیم شدند. پرونده بیماران برای 4 ویزیت متوالی پیگیری شد. با استفاده از آنالیز رگرسیون generalized equation model با و بدون میزان سازی برای سن، جنس، طول مدت دیابت و مصرف سیگار و شاخص توده بدنی (BMI)  اثر رژیم های دارویی روی فشار نبض و فشار خون در طی زمان به صورت جداگانه بررسی  شد.
نتایج: گروه های مورد مطالعه تغییر معنی داری در فشار نبض و فشار خون دیاستولیک و سیستولیک نداشتند. تفاوت معنی داری بین فشار نبض و فشارخون دیاستولیک گروه های مورد مطالعه وجود نداشت (فشار نبض p=0.090 و فشار خون دیاستولیک p=0.63). در مقایسه های دوتایی گروه های مورد مطالعه نیز تفاوت معنی داری در فشار نبض و فشار دیاستولیک و سیستولیک وجود نداشت. الگوی تغییرات فشارخون و نبض در گروه ها، در طی زمان تفاوتی با یکدیگر نداشتند.
نتیجه گیری: نتایج این مطالعه نشان داد که بیمارانی که متفورمین تنها مصرف می کنند فشار نبض و فشار خون سیستولیک بیشتری در طی زمان پیدا می کنند. به صورت میانگین، فشار خون و نبض بین گروه ها تفاوتی ندارد. الگوی تغییرات فشار نبض و خون در طی زمان بین گروه ها تفاوتی ندارد.
كليد واژه ها :
انسولین، گلیبنکلامید، متفورمین، فشار نبض، فشار خون سیستولیک، فشار خون دیاستولیک، دیابت شیرین تیپ 2

مشخصات دانشجو:
نام: حمید عالمی    رشته تحصيلي:  پزشکی     مقطع: دکتری عمومی    گروه آموزشي:داخلی          
پست الكترونيك دانشجو: alemister@gmail.com
اساتيد راهنما و داور:
استاد راهنما: آقای دکتر منوچهر نخجوانی / آقای دکتر محمدعلی منصورنیا
استاد مشاور: آقای دکتر علیرضا استقامتی
اساتيد داور:
آقای دکتر سید منصور گتمیری
خانم دکتر نوشین شیرزاد
خانم دکتر صغری ربیع زاده
زمان دفاع :
 روز دوشنبه   تاريخ 24/2/1397  ساعت 10:30
مكان دفاع به آدرس:
مجموعه بیمارستان امام خمینی، بیمارستان ولیعصر، طبقه پنجم، کلاس بخش غدد و متابولیسم
اطلاعات به زبان انگليسي
Title:
Blood pressure and pulse pressure difference among glucose lowering modality groups in type 2 diabetes
Abstract:
Objectives: Type 2 diabetes is associated with higher pulse pressure. In this study we assessed and compared effects of classic diabetes treatments on pulse pressure (PP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with type 2 diabetes.
Methods:  In a retrospective cohort study, 718 non-hypertensive patients with type 2 diabetes were selected and divided into four groups including metformin, insulin, glibenclamide+metformin and metformin+insulin. They were followed for four consecutive visits lasting about 45.5 months. Effects of drug regimens on pulse and blood pressure over time were assessed separately and compared by random-effect regression analysis and were adjusted for age, duration of diabetes, sex, smoking and BMI.
Results: Studied groups had no significant change in PP, SBP and DBP over time. No significant difference in PP and DBP among studied groups was observed (PP:P=0.109; DBP:P=0.056). Pairwise comparisons of PP, SBP and DBP showed no statistically significant contrast between any two studied groups. Interactions of time and treatment were not different among groups.  
Conclusion: Our results demonstrates classic hypoglycemic agents have no significant effect on type 2 diabetic patients SBP, DBP and PP over time. Averagely, pulse and blood pressure among groups were not different. Trends of variation in pulse and blood pressure were not different among studied diabetes treatments.
Keywords:
PP, pulse pressure; SBP, systolic blood pressure; DBP, diastolic blood pressure; DM2, type 2 diabetes mellitus; CVD, cardiovascular disease; Met, metformin; Glb, glibenclamide.

مشخصات مقاله:(در صورتي كه مقاله اي از پايان نامه چاپ يا پذيرش شده است )
عنوان مقاله:

Pulse pressure and diabetes treatments: Blood pressure and pulse pressure difference among glucose lowering modality groups in type 2 diabetes.


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