Almgren Torbjörn, Wilhelmsen Lars, Samuelsson Ola, Himmelmann Anders, Rosengren Annika, Andersson Ove K
Department of Internal Medicine, Sahlgrenska University Hospital, Goteborg, Sweden.
J Hypertens. 2007 Jun;25(6):1311-7. doi: 10.1097/HJH.0b013e328122dd58.
The objective of this study was to analyse predictive factors for development of type 2 diabetes during life-long therapy for hypertension and the alleged additional cardiovascular risk this constitutes.
The study group (n = 754) comprised the hypertensive subgroup of a randomized population sample of 7500 men, aged 47-54 years, screened for cardiovascular risk factors and followed for 25-28 years. The patients were treated with thiazide diuretics and beta-adrenergic blocking drugs with the addition of hydralazin during the first decade. Calcium antagonists were substituted for hydralazin and, if needed, angiotensin-converting enzyme inhibitors were added when these drugs became available.
A total of 148 (20.4%) treated hypertensive patients developed diabetes during 25 years, and in multivariate Cox regression analysis body mass index, serum triglycerides and treatment with beta-blockers were positively related with this complication. New-onset diabetes implied a significantly increased risk for stroke [hazard ratio (HR): 1.67; 95% confidence interval (95% CI): 1.1-2.6; P < 0.05], myocardial infarction (OR: 1.66; 95% CI: 1.1-2.5; P < 0.05) and mortality (OR: 1.42; 95% CI: 1.1-1.9; P < 0.05). The greatest risk for stroke was new-onset diabetes, followed by smoking (OR: 1.46; 95% CI: 1-2.2; P = 0.07) and the greatest risk for myocardial infarction was new-onset diabetes, followed by smoking (HR: 1.64; 95% CI: 1.1-2.4; P < 0.01). The greatest risk for mortality was smoking (HR: 1.73; 95% CI: 1.3-2.2; P < 0.005). Achieved systolic and diastolic blood pressure were not predictive of cardiovascular complications or death. The mean observation time from onset of diabetes mellitus to a first stroke was 9.1 years and to a first myocardial infarction 9.3 years.
Diabetes in treated hypertensive patients is alarmingly common and carries a high risk for cardiovascular complications and mortality.
本研究的目的是分析高血压终身治疗期间2型糖尿病发生的预测因素，以及由此构成的所谓额外心血管风险。
研究组（n = 754）包括从7500名年龄在47 - 54岁的男性随机人群样本中筛选出的高血压亚组，对其进行心血管危险因素筛查并随访25 - 28年。患者在最初十年接受噻嗪类利尿剂和β - 肾上腺素能阻滞剂治疗，并加用肼屈嗪。后来用钙拮抗剂替代肼屈嗪，如有需要，在血管紧张素转换酶抑制剂上市后加用此类药物。
在25年期间，共有148名（20.4%）接受治疗的高血压患者患糖尿病，多因素Cox回归分析显示体重指数、血清甘油三酯和β受体阻滞剂治疗与该并发症呈正相关。新发糖尿病意味着中风风险显著增加[风险比（HR）：1.67；95%置信区间（95%CI）：1.1 - 2.6；P < 0.05]、心肌梗死风险增加（OR：1.66；95%CI：1.1 - 2.5；P < 0.05）和死亡风险增加（OR：1.42；95%CI：1.1 - 1.9；P < 0.05）。中风的最大风险因素是新发糖尿病，其次是吸烟（OR：1.46；95%CI：1 - 2.2；P = 0.07）；心肌梗死的最大风险因素是新发糖尿病，其次是吸烟（HR：1.64；95%CI：1.1 - 2.4；P < 0.01）。死亡的最大风险因素是吸烟（HR：1.73；95%CI：1.3 - 2.2；P < 0.005）。所达到的收缩压和舒张压不能预测心血管并发症或死亡。从糖尿病发病到首次中风的平均观察时间为9.1年，到首次心肌梗死为9.3年。
接受治疗的高血压患者中糖尿病极为常见，且具有较高的心血管并发症和死亡风险。
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