1、Assess cardiovascular risk at diagnosis and at least annually thereafter:
——current or previous cardiovascular disease (CVD)
——age and BMI (abdominal adiposity)
——conventional cardiovascular (CV) risk factors including smoking and serum lipids, and family history of premature CVD
——other features of the metabolic syndrome and renal damage (including low HDL cholesterol, high triglycerides, raised albumin excretion rate)
——atrial fi brillation (for stroke).
Do not use risk equations developed for non-diabetic populations. The UKPDS risk engine may be used for assessment and communication of risk.
在诊断时和之后至少每年都评估心血管危险：
——目前或以前的心血管疾病（CVD）
——年龄和BMI（腹部肥胖）
——传统的心血管危险因素包括吸烟、血脂以及早发CVD家族史
——其他代谢综合征和肾脏损害的因素（包括低HDL胆固醇，高甘油三酯，白蛋白排泄率升高）
——心房颤动（对于中风）
对于非糖尿病人群不用危险方程。UKPDS风险评估可以用于评估和交流危险。
2、Ensure optimal management through lifestyle measures (see Lifestyle management), and measures directed at good blood glucose and blood pressure control (see Glucose control, Blood pressure control).
通过生活方式干预（见生活方式治疗节）、针对控制良好的血糖和血压的治疗方式（见血糖控制、血压控制节）保证最佳控制。
3、Arrange smoking cessation advice in smokers contemplative of reducing or stopping tobacco consumption.
为打算减少或停止烟草消耗吸烟者中提供戒烟建议。
4、Provide aspirin 75-100 mg daily (unless aspirin intolerant or blood pressure uncontrolled) in people with evidence of CVD or at high risk.
在有CVD或者CVD高危人群中每天给予75－100mg阿司匹林（除非不能耐受阿司匹林或者血压无法控制）。
5、Provide active management of the blood lipid profi le:
——a statin at standard dose for all >40 yr old (or all with declared CVD)
——a statin at standard dose for all >20 yr old with microalbuminuria or assessed as being at particularly high risk
——in addition to statin, fenofi brate where serum triglycerides are >2.3 mmol/l(>200 mg/dl), once LDL cholesterol is as optimally controlled as possible
——consideration of other lipid-lowering drugs (ezetimibe, sustained release nicotinic acid, concentrated omega 3 fatty acids) in those failing to reach lipidlowering targets or intolerant of conventional drugs.
Reassess at all routine clinical contacts to review achievement of lipid targets:
LDL cholesterol <2.5 mmol/l (<95 mg/dl), triglyceride <2.3 mmol/l(<200 mg/dl), and HDL cholesterol >1.0 mmol/l (>39 mg/dl).
积极控制血脂：
——在所有40岁以上人群（或者所有有CVD人群）应用一种标准计量的他汀
——在所有20岁以上的有微量白蛋白尿或者评估为特别高危人群中应用一种标准剂量的他汀
——在LDL胆固醇得到尽可能的理想控制时，如果血清甘油三酯>2.3 mmol/l(>200 mg/dl)，在他汀类药物之外加用贝特类药物
——在调脂不能达标或者不能耐受传统药物的人群中考虑应用其他降脂药物（依泽替米贝，持续释放的烟酸，浓缩ω3脂肪酸）
在临床随诊时重新评估下列指标以期达标：
LDL cholesterol <2.5 mmol/l (<95 mg/dl), triglyceride <2.3 mmol/l(<200 mg/dl), and HDL cholesterol >1.0 mmol/l (>39 mg/dl).
6、Refer early for further investigation and consideration of revascularization those with problematic or symptomatic peripheral arterial disease, those with problems from coronary artery disease, and those with evidence of carotid disease.
在有疑问或者有症状的外周动脉疾病，有冠心病相关问题以及有颈动脉疾病迹象的患者中早期考虑进一步的检查和血运重建
心血管危险因素控制之基础治疗：
1、Assessment will be as for Standard care, with lipid profi le measures if available.
评估同标准治疗，如果有可能的话还评估血脂水平。
2、Management will be as for Standard care, but using statins or fi brates only where these are available at reasonable cost from generics’ manufacturers, and in particular for those with known CVD. Statins may be used even if the serum lipid profi le cannot be measured.
治疗同标准治疗。但是只在能够从专利工厂处以合理价格获得贝特和他汀类药物的地方应用这两类药物，特别是在有已知CVD的人群中应用。甚至即使在不能够测量血脂的地方也可以应用他汀。
3、Revascularization procedures will generally not be available, but where possible those limited by symptoms should be so referred.
血运重建的技术通常不能够做到，但是在可以做到的地区，也应当对只有症状的人实施这种技术。
糖尿病患者高血压的控制
循证依据（较多，不详述）：
NHANESⅢ 1988－1994
ACCORD/ADVANCE研究
UKPDS研究
ABCD研究
FACET研究
MRFIT研究
CAPP研究
STOPHT研究
LIFE研究
2型糖尿病患者血压控制之标准治疗
1、Measure blood pressure annually, and at every routine clinic visit if found to be above target levels (see below), or if on treatment:
——use a mercury sphygmomanometer or validated meter in good working order and an appropriately sized cuff (large or normal depending on arm size)
——measure after sitting for at least 5 min, with arm at heart level, using fi rst and fi fth phases of Korotkoff sounds
——record all values in a record card held by the person with diabetes
——use 24-hour ambulatory monitoring (ABPM) if ‘white coat’ hypertension suspected, but adjust targets down by 10/5 mmHg.
每年检测血压，且再每次常规临床随诊时检测血压是否高于目标水平（见下），或者是否需要治疗：
——应用工作状态良好的水银血压计或者确证有效的计量仪，套袖大小要合适（根据胳膊的大小决定较大或者正常型号）。
——坐下至少5分钟后测量，胳膊放置在心脏水平，应用Korotkoff音第一和第五声来测量血压。
——把测量结果记载在糖尿病患者携带的记录卡上。
——应用24小时动态监护（ABPM）来判断是否存在‘白大褂’高血压，但是把目标值下调10/5 mmHg。
2、Consider secondary causes of raised blood pressure if there is evidence of renal disease, electrolyte disturbance or other features.
如果有肾脏疾病、电解质失调或者其他表现需要考虑继发性血压升高。
3、Aim to maintain blood pressure below 130/80 mmHg (for people with raised albumin excretion rate see Kidney damage).
Add further drugs if targets are not reached on maximal doses of current drugs, reviewing the preferences and beliefs of the individual concerned, and likely adherence problems as tablet numbers increase.
Accept that even 140/80 mmHg may not be achievable with 3 to 5 antihypertensive drugs in some people.
Revise individual targets upwards if there is signifi cant risk of postural hypotension and falls.
对于白蛋白排泄率增高的人群（见肾脏损害）目标是将患者的血压维持在130/80 mmHg以下。
在当前药物应用到最大剂量而没有治疗达标时加用其它药物，在增加药片数量时要注意考虑用药个体的用药倾向和信任度以及可能的依从性问题。
要接受这样一种观点：在某些个体中可能应用3－5种降压药物都不能达到140/80 mmHg 的控制水平。
如果有明显直立性低血压以及血压下降的危险时，将个体的血压控制目标升高。
4、Initiate a trial of lifestyle modifi cation alone with appropriate education for 3 months (see Lifestyle management), aiming to reduce calorie intake, salt intake, alcohol intake, and inactivity.
开始时应用3个月时间的单独的生活方式调整配合适当的教育（见生活方式治疗节），目标为减少热卡、盐和酒精摄入，以及静 坐状态。
5、Initiate medication for lowering blood pressure in diabetes not complicated by raised albumin excretion rate, using any agent except for α-adrenergic blockers, with consideration of costs, and actively titrating dose according to response:
——ACE-inhibitors and A2RBs may offer some advantages over other agents in some situations (see Kidney damage, Cardiovascular risk protection), but are less effective in people of African extraction
——start with β-adrenergic blockers in people with angina, β-adrenergic blockers or ACE-inhibitors in people with previous myocardial infarction, ACEinhibitors or diuretics in those with heart failure
——care should be taken with combined thiazide and β-adrenergic blockers because of risk of deterioration in metabolic control.
在没有合并白蛋白排泄率增高的糖尿病人群中起始降压药物的应用可以选择除α-肾上腺素阻滞剂的任何药物，要考虑药物的费用和有活性的药物剂量：
——在一些情况下（见肾脏损害、心血管危险保护节），ACEI和A2RBs可以提供一些优于其他药物的优势，但是在非洲人中效果较弱。
——在心绞痛患者中起始应用β-肾上腺素阻滞剂，在既往心肌梗死的人群中应用β-肾上腺素阻滞剂或ACEI，在心衰人群中起始应用ACEI或利尿剂。
——在合用噻嗪(类)和β-肾上腺素阻滞剂人群中要小心，因为可能有导致代谢控制恶化的危险。
2型糖尿病患者血压控制之基础治疗
1、Measurement and targets will be as for Standard care.
治疗目标同标准治疗。
2、Initiate a trial of lifestyle modifi cation (as Standard care) with appropriate education (see Lifestyle management).
起始应用生活方式改善治疗（见标准治疗）以及合适的教育（见生活方式改善节）。
3、Initiate medication for lowering blood pressure in diabetes not complicated by proteinuria, using generic diuretics, β-adrenergic blockers, calcium channel blockers, or ACE-inhibitors as available, increasing the number of preparations used according to drug availability locally.
在没有并发蛋白尿的糖尿病患者中降压起始治疗可以应用当地可以获得的一般利尿剂、β-肾上腺素阻滞剂、钙离子拮抗剂或者ACEI。根据当地可以获得的药物来增加所应用的降压药物的数量。
