Verdecchia Paolo, Reboldi Gianpaolo, Angeli Fabio, Borgioni Claudia, Gattobigio Roberto, Filippucci Lucia, Norgiolini Silvia, Bracco Costanza, Porcellati Carlo
Dipartimento Malattie Cardiovascolari, Università di Perugia, Ospedale R. Silvestrini S. Andrea delle Fratte 06122 Perugia, Italy.
Hypertension. 2004 May;43(5):963-9. doi: 10.1161/01.HYP.0000125726.92964.ab. Epub 2004 Mar 22.
Diabetes may develop in nondiabetic hypertensive subjects during treatment, but the long-term cardiovascular implications of this phenomenon are not clear. We determined the prognostic value of new diabetes in hypertensive subjects. In a long-term cohort study, 795 initially untreated hypertensive subjects, 6.5% of whom with type 2 diabetes, underwent diagnostic procedures including 24-hour ambulatory blood pressure (BP) monitoring and electrocardiography (ECG). Procedures were repeated after a median of 3.1 years in the absence of cardiovascular events. Follow-up duration was 1 to 16 years (median 6.0). New diabetes occurred in 5.8% of subjects initially without diabetes. Antihypertensive treatment included a diuretic in 53.5% of these subjects, versus 30.4% of those in whom diabetes did not develop (P=0.002). Plasma glucose at entry (P=0.0001) and diuretic treatment on follow-up (P=0.004) were independent predictors of new diabetes. Subsequent to the follow-up visit, a first cardiovascular event occurred in 63 subjects. Event rate in nondiabetic subjects at both visits, new diabetes, and diabetes at entry were 0.97, 3.90, and 4.70x100 person-years, respectively (P=0.0001). After adjustment for several confounders, including 24-hour ambulatory BP, the relative risk of events was 2.92 (95% CI: 1.33 to 6.41; P=0.007) in the group with new diabetes and 3.57 (95% CI: 1.65 to 7.73; P=0.001) in the group with previous diabetes, when compared with the group persistently free of diabetes. In treated hypertensive subjects, occurrence of new diabetes portends a risk for subsequent cardiovascular disease that is not dissimilar from that of previously known diabetes.
非糖尿病高血压患者在治疗过程中可能会发生糖尿病，但这种现象对长期心血管疾病的影响尚不清楚。我们确定了高血压患者新发糖尿病的预后价值。在一项长期队列研究中，795名初始未接受治疗的高血压患者（其中6.5%患有2型糖尿病）接受了包括24小时动态血压监测和心电图检查在内的诊断程序。在无心血管事件的情况下，中位3.1年后重复进行这些检查。随访时间为1至16年（中位6.0年）。最初无糖尿病的患者中有5.8%发生了新发糖尿病。这些患者中有53.5%接受了包括利尿剂在内的降压治疗，而未发生糖尿病的患者中这一比例为30.4%（P=0.002）。基线血糖水平（P=0.0001）和随访期间的利尿剂治疗（P=0.004）是新发糖尿病的独立预测因素。随访后，63名患者发生了首次心血管事件。两次就诊时均无糖尿病的患者、新发糖尿病患者和基线糖尿病患者的事件发生率分别为0.97、3.90和4.70/100人年（P=0.0001）。在调整了包括24小时动态血压在内的多个混杂因素后，与持续无糖尿病的组相比，新发糖尿病组的事件相对风险为2.92（95%CI：1.33至6.41；P=0.007），既往有糖尿病组的事件相对风险为3.57（95%CI：1.65至7.73；P=0.001）。在接受治疗的高血压患者中，新发糖尿病预示着随后发生心血管疾病的风险，这与既往已知糖尿病患者的风险并无不同。
