Izzo Raffaele, de Simone Giovanni, Chinali Marcello, Iaccarino Guido, Trimarco Valentina, Rozza Francesco, Giudice Renata, Trimarco Bruno, De Luca Nicola
Department of Clinical Medicine, Cardiovascular, and Immunological Sciences, Federico II University-Naples, Naples, Italy.
Diabetes Care. 2009 May;32(5):845-50. doi: 10.2337/dc08-1881. Epub 2009 Feb 17.
Incidence of type 2 diabetes might be associated with preexisting hypertension. There is no information on whether incident diabetes is predicted by blood pressure control. We evaluated the hazard of diabetes in relation to blood pressure control in treated hypertensive patients.
Nondiabetic, otherwise healthy, hypertensive patients (N = 1,754, mean +/- SD age 52 +/- 11 years, 43% women) participated in a network over 3.4 +/- 1 years of follow-up. Blood pressure was considered uncontrolled if systolic was >or=140 mmHg and/or diastolic was >or=90 mmHg at the last outpatient visit. Diabetes was defined according to American Diabetes Association guidelines.
Uncontrolled blood pressure despite antihypertensive treatment was found in 712 patients (41%). At baseline, patients with uncontrolled blood pressure were slightly younger than patients with controlled blood pressure (51 +/- 11 vs. 53 +/- 12 years, P < 0.001), with no differences in sex distribution, BMI, duration of hypertension, baseline blood pressure, fasting glucose, serum creatinine and potassium, lipid profile, or prevalence of metabolic syndrome. During follow-up, 109 subjects developed diabetes. Incidence of diabetes was significantly higher in patients with uncontrolled (8%) than in those with controlled blood pressure (4%, odds ratio 2.08, P < 0.0001). In Cox regression analysis controlling for baseline systolic blood pressure and BMI, family history of diabetes, and physical activity, uncontrolled blood pressure doubled the risk of incident diabetes (hazard ratio [HR] 2.10, P < 0.001), independently of significant effects of age (HR 1.02 per year, P = 0.03) and baseline fasting glucose (HR 1.10 per mg/dl, P < 0.001).
In a large sample of treated nondiabetic hypertensive subjects, uncontrolled blood pressure is associated with twofold increased risk of incident diabetes independently of age, BMI, baseline blood pressure, or fasting glucose.
2型糖尿病的发病率可能与既往高血压有关。关于血压控制是否能预测新发糖尿病，目前尚无相关信息。我们评估了接受治疗的高血压患者中，血压控制与糖尿病发生风险之间的关系。
非糖尿病、其他方面健康的高血压患者（N = 1754，平均±标准差年龄52±11岁，43%为女性）参与了一个随访时间为3.4±1年的网络研究。如果在最后一次门诊就诊时收缩压≥140 mmHg和/或舒张压≥90 mmHg，则认为血压未得到控制。糖尿病根据美国糖尿病协会指南进行定义。
712例患者（41%）尽管接受了降压治疗，但血压仍未得到控制。在基线时，血压未得到控制的患者比血压得到控制的患者略年轻（51±11岁对53±12岁，P < 0.001），在性别分布、体重指数、高血压病程、基线血压、空腹血糖、血清肌酐和钾、血脂谱或代谢综合征患病率方面无差异。在随访期间，109名受试者患上了糖尿病。血压未得到控制的患者中糖尿病的发病率（8%）显著高于血压得到控制 的患者（4%），优势比为2.08，P < 0.0001。在控制了基线收缩压和体重指数、糖尿病家族史以及身体活动的Cox回归分析中，血压未得到控制使新发糖尿病的风险增加了一倍（风险比[HR] 2.10，P < 0.001），独立于年龄（每年HR 1.02，P = 0.03）和基线空腹血糖（每毫克/分升HR 1.10，P < 0.001）的显著影响。
在大量接受治疗的非糖尿病高血压受试者样本中, 血压未得到控制与新发糖尿病风险增加两倍相关，且独立于年龄、体重指数、基线血压或空腹血糖。
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