Section of Endocrinology, VA Medical Center, Omaha, Nebraska, USA.
Diabetes Care. 2011 Jan;34(1):34-8. doi: 10.2337/dc10-1420. Epub 2010 Nov 8.
Blood pressure ranges associated with cardiovascular disease (CVD) events in advanced type 2 diabetes are not clear. Our objective was to determine whether baseline and follow-up (On-Study) systolic blood pressure (SBP), diastolic blood pressure (DBP), and SBP combined with DBP predict CVD events in the Veterans Affairs Diabetes Trial (VADT).
Participants in the VADT (n = 1,791) with hypertension received stepped treatment to maintain blood pressure below the target of 130/80 mmHg in standard and intensive glycemic treatment groups. Blood pressure levels of all subjects at baseline and On-Study were analyzed to detect associations with CVD risk. The primary outcome was the time from randomization to the first occurrence of myocardial infarction, stroke, congestive heart failure, surgery for vascular disease, inoperable coronary disease, amputation for ischemic gangrene, or CVD death.
Separated SBP ≥140 mmHg had significant risk at baseline (hazards ratio [HR] 1.508, P < 0.001) and On-Study (HR 1.469, P = 0.002). DBP <70 mmHg increased CVD events at baseline (HR 1.482, P < 0.001) and On-Study (HR 1.491, P < 0.001). Combined blood pressure categories indicated high risk for CVD events for SBP ≥140 with DBP <70 mmHg at baseline (HR 1.785, P = 0.03) and On-Study (HR 2.042, P = 0.003) and nearly all SBP with DBP <70 mmHg.
Increased risk of CVD events with SBP ≥140 mmHg emphasizes the urgency for treatment of systolic hypertension. Increased risk with DBP <70 mmHg, even when combined with SBP in guideline-recommended target ranges, supports a new finding in patients with type 2 diabetes. The results emphasize that DBP <70 mmHg in these patients was associated with elevated CVD risk and may best be avoided.
在 2 型糖尿病晚期，与心血管疾病（CVD）事件相关的血压范围尚不清楚。我们的目的是确定基线和随访期间（研究期间）的收缩压（SBP）、舒张压（DBP）以及 SBP 和 DBP 的组合是否可以预测退伍军人事务糖尿病试验（VADT）中的 CVD 事件。
VADT 中的高血压参与者（n=1791）接受了分级治疗，以将血压维持在标准和强化血糖治疗组中低于 130/80mmHg 的目标值以下。分析所有受试者的基线和研究期间的血压水平，以检测与 CVD 风险的关联。主要结局是从随机分组到首次发生心肌梗死、中风、充血性心力衰竭、血管疾病手术、无法手术的冠心病、缺血性坏疽的截肢或 CVD 死亡的时间。
基线时 SBP≥140mmHg 具有显著风险（风险比[HR]1.508，P<0.001）和研究期间（HR1.469，P=0.002）。DBP<70mmHg 增加了基线时的 CVD 事件（HR1.482，P<0.001）和研究期间（HR1.491，P<0.001）。综合血压类别表明，基线时 SBP≥140mmHg 与 DBP<70mmHg 结合时 CVD 事件风险较高（HR1.785，P=0.03），而研究期间（HR2.042，P=0.003）和几乎所有 SBP 与 DBP<70mmHg 时的风险较高。
SBP≥140mmHg 时 CVD 事件风险增加强调了治疗收缩期高血压的紧迫性。即使与指南推荐的目标范围内的 SBP 结合，DBP<70mmHg 时风险增加也支持 2 型糖尿病患者的新发现。结果强调，这些患者的 DBP<70mmHg 与 CVD 风险升高相关，可能最好避免。
