Astrup Anne Sofie, Nielsen Flemming S, Rossing Peter, Ali Samir, Kastrup Jens, Smidt Ulla Meng, Parving Hans-Henrik
Steno Diabetes Center, Gentofte, Denmark.
J Hypertens. 2007 Dec;25(12):2479-85. doi: 10.1097/HJH.0b013e3282f06428.
To evaluate the prognostic significance of cardiovascular risk factors including 24-h ambulatory blood pressure level and rhythm for all-cause mortality in type 2 diabetic patients.
In a prospective observational study, 104 patients with type 2 diabetes were followed: 51 patients with diabetic nephropathy and 53 patients with persistent normoalbuminuria. At baseline, 24-h ambulatory blood pressure, left ventricular hypertrophy, glomerular filtration rate and cardiac autonomic neuropathy were measured. Blood samples were taken and patients answered a World Health Organization questionnaire. Dipping was calculated as the average nocturnal reduction in systolic and diastolic blood pressure.
Mean follow-up was 9.2 years (range 0.5-12.9). During follow-up, 54 of 104 patients died. Sixteen patients (15%) had higher blood pressure at night than during the day (reversed pattern); 14 of these patients died (88%), compared to 40 of 88 patients (45%) with reduced dipping or normal dipping; log rank P = 0.001. In a Cox regression analysis, predictors of all-cause mortality were: age, male sex, presence of left ventricular hypertrophy, glycated haemoglobin A1c (HbA1c), daytime systolic blood pressure, cardiac autonomic neuropathy, glomerular filtration rate and dipping (1% increase; hazard ratio 0.97, 95% confidence interval 0.94-0.998, P = 0.033).
Type 2 diabetes patients with non-dipping of night blood pressure were at higher risk of death as compared to dippers, independent of known cardiovascular risk factors. Since non-dipping has a high prevalence in patients with diabetic nephropathy, 24-h ambulatory blood pressure should be used to assess a full risk profile and blood pressure-lowering therapy in these patients.
评估包括24小时动态血压水平及节律在内的心血管危险因素对2型糖尿病患者全因死亡率的预后意义。
在一项前瞻性观察性研究中，对104例2型糖尿病患者进行随访：51例糖尿病肾病患者和53例持续性正常白蛋白尿患者。在基线时，测量24小时动态血压、左心室肥厚、肾小球滤过率和心脏自主神经病变。采集血样并让患者回答一份世界卫生组织问卷。夜间血压下降幅度通过收缩压和舒张压的夜间平均降低值来计算。
平均随访时间为9.2年（范围0.5 - 12.9年）。随访期间，104例患者中有54例死亡。16例患者（15%）夜间血压高于白天（反勺型模式）；其中14例患者死亡（88%），相比之下，88例勺型或非勺型血压降低患者中有40例死亡（45%）；对数秩检验P = 0.001。在Cox回归分析中，全因死亡率的预测因素为：年龄、男性、左心室肥厚的存在、糖化血红蛋白A1c（HbA1c）、白天收缩压、心脏自主神经病变、肾小球滤过率和夜间血压下降幅度（每增加1%；风险比0.97，95%置信区间0.94 - 0.998，P = 0.033）。
与勺型血压患者相比，夜间血压非勺型的2型糖尿病患者死亡风险更高，且独立于已知的心血管危险因素。由于糖尿病肾病患者中非勺型血压的患病率较高，应使用24小时动态血压来评估这些患者的全面风险状况并指导降压治疗。
