Background: Hypertension is more prevalent in subjects with impaired glucose tolerance (IGT), but whether higher blood pressure per se or the mild hyperglycemia in combination with the hypertension enhanced the risk of cardiovascular disease (CVD) remains unclear.
Methods: Five hundred and sixty-eight participants with IGT in the original Daqing diabetes prevention study, 297 with hypertension (HBP) and 271 without hypertension (NBP), were enrolled in 1986 and the intervention phase lasted for 6 years. In 2009, they were followed up to assess the outcomes of cardiovascular events (including stroke and myocardial infarction) and incidence of diabetes.
Results: Over 23 years, the incidence of diabetes was 93.9/1000 person-years in HBP and 72.2/1000 person-years in the NBP group, with an age- and sex-adjusted hazard ratio of 1.26 (95% confidence interval [CI], 1.04-1.54, P = 0.02). The yearly incidence of CVD events was 27.7/1000 person-years and 16.6/1000 person-years, indicating a 35% higher risk in HBP than in the NBP group (95% CI, 1.01-1.81; P = 0.04). Cox proportional hazard analysis showed that a 10-mm Hg increase of the baseline systolic blood pressure was associated with 9% increased risk of the development of diabetes (P = 0.02), together with a 7% higher risk of the CVD events (P = 0.02).
Conclusions: Hypertension predicted diabetes and enhances long-term risk of CVD events in patients with IGT. An individualized strategy that targets hypertension as well as hyperglycemia is needed for diabetes and its cardiovascular complications.
背景: 高血压在糖耐量受损(impaired glucose tolerance，IGT)人群中更为普遍。而它对心血管疾病(CVD)的影响是来自高血压本身还是轻度高血糖与血压的共同作用尚不清楚。 方法: 1986年大庆糖尿病预防研究初始纳入IGT患者568例，分为IGT伴高血压组297例，IGT不伴高血压组271例。对IGT患者进行6年生活方式干预。随访至2009年评估两组的新发糖尿病和心血管事件(包括脑卒中和急性心肌梗死)发生率。 结果: 随访23年中，IGT伴高血压组和不伴高血压组的2型糖尿病发生率分别为93.9/千人/年和72.2/千人/年。校正年龄和性别影响后，IGT伴高血压组的糖尿病发病风险为非高血压组1.26倍[95%可信区间(CI)，1.04-1.54，P = 0.02]。心血管事件的发生率在IGT伴高血压组为27.7/千人/年，不伴高血压组为16.6/千人/年，与不伴高血压组相比，IGT伴高血压组的发病风险增加35%(95% CI，1.01-1.81，P = 0.04]。COX比例风险分析显示基线收缩压每升高10 mmHg，糖尿病的发生风险增加9.0%(P = 0.02)，同时心血管事件的发生风险增加7%(P = 0.02)。 结论: 在糖耐量受损人群中，高血压预测2型糖尿病的发生，并提高长期心血管事件的发生风险。个体化治疗策略应是降糖的同时还兼顾降压，以预防糖尿病及心血管并发症发生。.
Keywords: blood pressure; cardiovascular disease events; diabetes incidence; impaired glucose tolerance; 心血管事件; 糖尿病发病率; 糖耐量受损; 血压.
© 2018 The Authors. Journal of Diabetes published by John Wiley & Sons Australia, Ltd and Ruijin Hospital, Shanghai Jiaotong University School of Medicine.