Bozorgmanesh Mohammadreza, Hadaegh Farzad, Mohebi Reza, Ghanbarian Arash, Eskandari Fatemeh, Azizi Fereidoun
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences (RIES), Shahid Beheshti University of Medical Sciences , Tehran , Iran.
Blood Press. 2013 Oct;22(5):317-24. doi: 10.3109/08037051.2013.769294. Epub 2013 Mar 5.
To determine the extent to which burden of cardiovascular disease (CVD) outcomes among diabetic population is attributable to hypertension. Nine-year follow-up data were secured for 7068 participants aged ≥ 20 years old, free from CVD at baseline. Cox proportional hazards regression was implemented to estimate hazard ratios (HRs) of hypertension. Population-attributable hazard fraction (PAHF) was used to assess proportion of diabetic population hazard of CVD events and mortality attributable to hypertension. In the whole population, irrespective of diabetes or hypertension status, incidence rate (95% CI) of CVD, coronary heart disease (CHD), as well as CVD and all-cause mortality per 1000 person-year were 8.3 (7.6-9.0), 7.1 (6.5-7.8), 1.8 (1.5-2.1) and 3.9 (3.5-4.5), respectively. Among diabetes participants, hypertension was a risk factor for CHD (HR = 1.63, 95% CI 1.15-2.03), CVD (HR = 1.74, 95% CI 1.50-2.41), CVD mortality (HR = 1.65, 95% CI 0.87-3.12) and all-cause mortality (HR = 1.53, 95% CI 0.97-2.42). HRs, however, were not statistically significant for all-cause or CVD mortality. PAHFs (%) of hypertension was 27.5 (95% CI 8.3-42.6) for CHD, 29.6 (95% CI 10.6-44.4) for CVD, 27.9 (95% CI - 17.2 to 55.7) for CVD mortality and 22.6 (95% CI - 5.9 to 43.4) for all-cause mortality. Our study shows that there is an excess risk of CVD in hypertensive patients with diabetes related to inadequate control of blood pressure.
为确定糖尿病患者心血管疾病（CVD）结局负担在多大程度上可归因于高血压。获取了7068名年龄≥20岁、基线时无CVD的参与者的9年随访数据。采用Cox比例风险回归来估计高血压的风险比（HRs）。人群归因风险分数（PAHF）用于评估糖尿病患者CVD事件和死亡风险中可归因于高血压的比例。在整个人口中，无论糖尿病或高血压状态如何，每1000人年的CVD、冠心病（CHD）以及CVD和全因死亡率的发病率（95%CI）分别为8.3（7.6 - 9.0）、7.1（6.5 - 7.8）、1.8（1.5 - 2.1）和3.9（3.5 - 4.5）。在糖尿病参与者中，高血压是CHD（HR = 1.63，95%CI 1.15 - 2.03）、CVD（HR = 1.74，95%CI 1.50 - 2.41）、CVD死亡率（HR = 1.65，95%CI 0.87 - 3.12）和全因死亡率（HR = 1.53，95%CI 0.97 - 2.42）的危险因素。然而，全因或CVD死亡率的HRs无统计学意义。高血压的PAHFs（%）对于CHD为27.5（95%CI 8.3 - 42.6），对于CVD为29.6（95%CI 10.6 - 44.4），对于CVD死亡率为27.9（95%CI - 17.2至55.7），对于全因死亡率为22.6（95%CI - 5.9至43.4）。我们的研究表明，糖尿病高血压患者中存在与血压控制不佳相关的CVD额外风险。
