Department of Medicine, Turku University Hospital, University of Turku, Turku, Finland.
J Intern Med. 2012 Dec;272(6):611-9. doi: 10.1111/j.1365-2796.2012.02581.x. Epub 2012 Sep 24.
Hypertension and proteinuria are major risk factors for cardiovascular disease (CVD) mortality in patients with type 2 diabetes. Blood pressure (BP) targets have been progressively lowered in these patients to prevent or delay the progression of nephropathy. However, no long-term population-based studies have been reported on the interaction between BP and proteinuria with respect to total and CVD mortality in patients with type 2 diabetes.
We prospectively followed 881 middle-aged type 2 diabetic patients, free of CVD events at baseline, for up to 18 years. Participants were categorized into four groups according to baseline systolic BP (<130, 130-139, 140-159 and ≥160 mmHg) and further stratified by proteinuria (≤150 or >150 mg L(-1)). Cox proportional hazards model was used to estimate the joint association between systolic BP and proteinuria and the risk of mortality.
During follow-up, 607 patients died including 395 because of CVD. After adjustment for confounding factors, total and CVD mortality were significantly higher in patients with proteinuria and systolic BP <130 mmHg compared with those with systolic BP between 130 and 160 mmHg. The prognosis was similar in patients with systolic BP <130 mmHg or ≥160 mmHg. Among patients without proteinuria, systolic BP <130 mmHg was associated with a nonsignificant reduction in mortality.
Type 2 diabetic patients with proteinuria and with systolic BP <130 mmHg may have an increased risk of CVD mortality. The presence of proteinuria should be taken into account when defining the target systolic BP level for the prevention of fatal CVD events in patients with type 2 diabetes.
高血压和蛋白尿是 2 型糖尿病患者心血管疾病（CVD）死亡的主要危险因素。为了预防或延缓肾病进展，这些患者的血压（BP）目标已逐步降低。然而，尚未有长期基于人群的研究报告 2 型糖尿病患者的 BP 和蛋白尿与总死亡率和 CVD 死亡率之间的相互作用。
我们前瞻性地随访了 881 名无 CVD 事件的中年 2 型糖尿病患者，随访时间长达 18 年。根据基线收缩压（<130、130-139、140-159 和≥160mmHg），将参与者分为四组，并进一步根据蛋白尿（≤150 或>150mgL(-1)）进行分层。Cox 比例风险模型用于估计收缩压和蛋白尿之间的联合作用与死亡率的风险。
在随访期间，607 名患者死亡，其中 395 人死于 CVD。在调整混杂因素后，与收缩压在 130-160mmHg 之间的患者相比，蛋白尿和收缩压<130mmHg 的患者的总死亡率和 CVD 死亡率明显更高。收缩压<130mmHg 或≥160mmHg 的患者预后相似。在无蛋白尿的患者中，收缩压<130mmHg 与死亡率的降低无显著相关性。
患有蛋白尿和收缩压<130mmHg 的 2 型糖尿病患者可能有更高的 CVD 死亡率风险。在定义 2 型糖尿病患者预防致命 CVD 事件的目标收缩压水平时，应考虑蛋白尿的存在。
