Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Diabetes Care. 2011 Jul;34(7):1534-9. doi: 10.2337/dc11-0441.
The goals of this study were to examine trajectories of blood pressure (BP) in adults with diabetes and investigate the association of trajectory patterns with mortality.
A nonconcurrent longitudinal design was used to monitor 3,766 Medicare patients with diabetes from 2005 through 2008. Data were extracted from a registry of Medicare beneficiaries, which was developed by a large academic practice that participated in the Physician Group Practice Medicare Demonstration. The relationship between BP trajectories and all-cause mortality was modeled using multilevel mixed-effects linear regression.
During the 4-year study period, 10.7% of the patients died, half of whom were aged≥75 years. The crude and adjusted models both showed a greater decline in systolic and diastolic BP in patients who died than in those who did not die. In a model adjusted for age, sex, race, medications, and comorbidities, the mean systolic BP decreased by 3.2 mmHg/year (P<0.001) in the years before death and by 0.7 mmHg/year (P<0.001) in those who did not die (P<0.001 for the difference in slopes). Similarly, diastolic BP declined by 1.3 mmHg/year for those who died (P<0.001) and by 0.6 mmHg/year for those who did not die (P<0.001); the difference in slopes was significant (P=0.021).
Systolic and diastolic BP both declined more rapidly in the 4 years before death than in patients who remained alive.
本研究旨在探讨糖尿病患者的血压（BP）轨迹，并研究轨迹模式与死亡率之间的关联。
采用非同期纵向设计，对 2005 年至 2008 年间的 3766 名 Medicare 糖尿病患者进行监测。数据取自 Medicare 受益人的登记处，该登记处由一家大型学术实践机构开发，参与了医师集团实践 Medicare 示范项目。采用多级混合效应线性回归模型，对 BP 轨迹与全因死亡率之间的关系进行建模。
在 4 年的研究期间，有 10.7%的患者死亡，其中一半年龄≥75 岁。未校正和校正模型均显示，死亡患者的收缩压和舒张压下降幅度大于未死亡患者。在调整年龄、性别、种族、药物和合并症后，死亡前患者的收缩压每年下降 3.2mmHg（P<0.001），未死亡患者每年下降 0.7mmHg（P<0.001）（斜率差异有统计学意义，P<0.001）。同样，死亡患者的舒张压每年下降 1.3mmHg（P<0.001），未死亡患者每年下降 0.6mmHg（P<0.001）；斜率差异有统计学意义（P=0.021）。
与存活患者相比，死亡前 4 年内收缩压和舒张压下降速度更快。
