Objective: To determine the association between pulse pressure and the risk of new-onset diabetes in hypertensive patients. Methods: In this prospective cohort study, hypertensive patients from the Kailuan Study, who were diagnosed in 2006-2007 check-up, were screened for enrollment. Participants who finished the biennial follow-up until December 31, 2017 were finally included in this analysis. The primary outcome was incident diabetes development. The pulse pressure variables were divided into quartiles (Q1-Q4), and the Kaplan-Meier curve was used to examine and estimate the cumulative incidence of new-onset diabetes among quartiles. Cox proportional hazards regression model was performed to explore the association between pulse pressure and the risk of new-onset diabetes in hypertensive patients. Results: During an average follow-up of 8.17 years, 6 617 new-onset diabetes were identified out of the 32 917 hypertensive patients with no history or evidence of diabetes in 2006-2007 check-up. Participants were classified into quartiles according to pulse pressure levels as follows: Q1 group(<41 mmHg (1mmHg=0.133kPa))(n=7 995); Q2 group(41-<51 mmHg) (n=8 196); Q3 group (51-<61 mmHg) (n= 8 270); Q4 group (≥61 mmHg) (n=8 456). The cumulative incidences of new-onset diabetes across the quartiles were 16.94%, 19.61%, 21.07%, and 22.33%, respectively, with the incidence density was 20.27, 23.20, 24.92, and 26.10 per 1 000 person-years, respectively. The cumulative incidence of new-onset diabetes increased in proportion with increasing pulse pressure levels (P<0.01 by the Log-rank test). After multivariate adjustment, compared with the first quartile, the hazard ratios for new-onset diabetes in the third and fourth quartiles were 1.13 (95%CI 1.04-1.22, P<0.01) and 1.14 (95%CI 1.05-1.24, P<0.01), respectively. The risk of new-onset diabetes increased 5%(HR=1.05, 95%CI 1.02-1.08, P<0.01) with the fractional pulse pressure increased per 1 SD (0.13). Findings from the three sensitivity analyses were consistent with the main results in this cohort. Conclusions: Pulse pressure at baseline is positively associated with the incidence of new-onset diabetes among hypertensive individuals, and pulse pressure is an independent risk factor for the development of diabetes in hypertensive patients.
目的： 探讨脉压对高血压人群新发糖尿病的影响。 方法： 该研究为前瞻性队列研究，选取开滦研究中参加2006年至2007年健康体检且后续进行了随访的原发性高血压患者作为研究对象，以完成2006年至2007年健康体检时间点作为随访起点，以新发糖尿病作为终点事件，2016年至2017年体检时间为末次随访时间。按脉压四分位将研究对象分为4组，即Q1组、Q2组、Q3组和Q4组。采用Kaplan-Meier生存曲线分析各脉压组新发糖尿病的累积发生率，采用Cox回归模型分析基线脉压对高血压人群新发糖尿病的影响。 结果： 研究最终纳入32 917位研究对象，随访（8.17±2.99）年，随访期间新发糖尿病6 617例（19.31%），研究人群中Q1组7 995例［脉压<41 mmHg（1 mmHg=0.133kPa）］、Q2组8 196例（脉压41~<51 mmHg）、Q3组8 270例（脉压51~<61 mmHg）、Q4组8 456例（脉压≥61 mmHg），各组人群新发糖尿病累积发病率分别为16.94%、19.61%、21.07%、22.33%，发病密度分别为20.27、23.20、24.92、26.10/千人年，新发糖尿病的累积发病率随着脉压的升高而上升（χ2=50.35，P<0.01）。多因素Cox回归分析结果显示，校正混杂因素后Q3组和Q4组高血压患者新发糖尿病风险分别是Q1组的1.13（95%CI 1.04~1.22，P<0.01）、1.14（95%CI 1.05~1.24，P<0.01）倍，脉压/平均动脉压比值每增加1个标准差（0.13），新发糖尿风险增加5%（HR=1.05，95%CI 1.02~1.08，P<0.01）。敏感性分析结果与主要研究结果趋势一致。 结论： 脉压与高血压人群新发糖尿病发病率呈正相关，高脉压是高血压人群新发糖尿病的独立危险因素。.