Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
Diabetes Care. 2013 Jan;36(1):77-83. doi: 10.2337/dc12-0708. Epub 2012 Sep 10.
Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications analyses demonstrated that intensive insulin therapy was inversely associated with incident hypertension. We thus sought to confirm these observations and, given sex differences in other type 1 diabetes complications and risk factors, assessed whether any such associations differ by sex.
Participants of a prospective cohort of childhood-onset type 1 diabetes, free of hypertension at study entry (baseline mean age, 28 years; diabetes duration, 19 years), were selected for study (n = 510). Hypertension incidence was defined as blood pressure >140/90 mmHg or use of hypertension medications in two consecutive visits. Intensive insulin therapy was defined as three or more injections (or pump) and four or more glucose tests daily. Baseline predictors of hypertension were examined using Cox proportional hazards models. Models with time-dependent updated means of baseline significant variables were also constructed.
Hypertension incidence over 18 years of follow-up was marginally higher in men than in women (43.2 vs. 35.4%, P = 0.07). A significant interaction was noted between sex and HbA(1c), and separate models were constructed by sex. Multivariably, elevated HbA(1c) was a significant predictor only in men (hazard ratio 1.48 [95% CI 1.28-1.71]). In time-dependent models, although a significant effect of HbA(1c) was also seen in women (1.21 [1.00-1.46]), the effect of glycemic control on hypertension development remained stronger in men (1.59 [1.29-1.97], P interaction <0.0001).
Although hyperglycemia is a risk factor for hypertension, its effect is stronger in men compared with women with type 1 diabetes.
糖尿病控制与并发症试验/糖尿病干预与并发症的流行病学分析表明，强化胰岛素治疗与高血压的发生呈负相关。因此，我们试图证实这些观察结果，并且鉴于 1 型糖尿病的其他并发症和危险因素存在性别差异，我们评估了这种关联是否存在性别差异。
选择前瞻性队列研究中儿童起病的 1 型糖尿病患者，在研究入组时（基线平均年龄为 28 岁；糖尿病病程为 19 年）无高血压（n=510）。高血压的发生定义为血压>140/90mmHg 或在两次连续就诊中使用高血压药物。强化胰岛素治疗定义为每天注射（或泵）三次或更多次和进行四次或更多次血糖检测。使用 Cox 比例风险模型检查高血压的基线预测因素。还构建了具有基于时间的基线显著变量更新均值的模型。
在 18 年的随访期间，男性的高血压发生率略高于女性（43.2%比 35.4%，P=0.07）。注意到性别和 HbA1c 之间存在显著的交互作用，并按性别分别构建模型。多变量分析显示，仅在男性中，HbA1c 升高是显著的预测因素（危险比 1.48[95%CI 1.28-1.71]）。在基于时间的模型中，尽管在女性中也观察到 HbA1c 的显著影响（1.21[1.00-1.46]），但血糖控制对高血压发展的影响在男性中更强（1.59[1.29-1.97]，P 交互<0.0001）。
尽管高血糖是高血压的危险因素，但它对 1 型糖尿病男性的影响强于女性。
