Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, Louisiana 70808, USA.
J Clin Endocrinol Metab. 2013 Sep;98(9):3653-62. doi: 10.1210/jc.2013-1757. Epub 2013 May 28.
Blood pressure (BP) control can reduce the risk of stroke among diabetic patients; however, it is not known whether the lowest risk of stroke is among diabetic patients with the lowest BP level.
Our objective was to investigate the race-specific association of different levels of BP with stroke risk among diabetic patients in the Louisiana State University Hospital-based longitudinal study.
DESIGN, SETTING, AND PARTICIPANTS: We prospectively investigated the race-specific association of different levels of BP at baseline and during an average of 6.7 years of follow-up with incident stroke risk among 17,536 African American and 12,618 white diabetic patients within the Louisiana State University Hospital System.
We evaluated incident stroke until May 31, 2012.
During follow-up, 2949 incident cases of stroke were identified. The multivariable-adjusted hazard ratios of stroke associated with different levels of systolic/diastolic BP at baseline (<110/65, 110-119/65-69, 120-129/70-80 [reference group], 130-139/80-90, 140-159/90-100, and ≥160/100 mm Hg) were 1.88 (95% confidence interval = 1.38-2.56), 1.05 (0.80-1.42), 1.00, 1.05 (0.86-1.27), 1.12 (0.94-1.34), and 1.47 (1.24-1.75) for African American diabetic patients and 1.42 (1.06-1.91), 1.22 (0.95-1.57), 1.00, 0.88 (0.72-1.06), 1.02 (0.86-1.21), and 1.28 (1.07-1.54) for white diabetic patients, respectively. A U-shaped association of isolated systolic or diastolic BP at baseline and during follow-up with stroke risk was observed among both African American and white diabetic patients. The U-shaped association was confirmed in both patients who were and were not taking antihypertensive drugs.
The current study suggests a U-shaped association between BP and the risk of stroke. Aggressive BP control (<110/65 mm Hg) and high BP (≥160/100 mm Hg) are associated with an increased risk of stroke among both African American and white patients with type 2 diabetes.
血压（BP）控制可以降低糖尿病患者中风的风险；然而，目前尚不清楚中风风险最低的糖尿病患者是否具有最低的 BP 水平。
我们的目的是在路易斯安那州立大学医院的纵向研究中，调查不同 BP 水平与糖尿病患者中风风险的种族特异性关联。
设计、地点和参与者：我们前瞻性地研究了不同水平的 BP 在基线和平均 6.7 年的随访期间与路易斯安那州立大学医院系统内 17536 名非裔美国人和 12618 名白人糖尿病患者中风风险的种族特异性关联。
我们评估了截至 2012 年 5 月 31 日的中风事件。
在随访期间，确定了 2949 例中风事件。多变量调整后的收缩压/舒张压水平与中风风险的比值（<110/65、110-119/65-69、120-129/70-80[参考组]、130-139/80-90、140-159/90-100 和≥160/100mmHg）分别为 1.88（95%置信区间=1.38-2.56）、1.05（0.80-1.42）、1.00、1.05（0.86-1.27）、1.12（0.94-1.34）和 1.47（1.24-1.75）的非裔美国糖尿病患者，以及 1.42（1.06-1.91）、1.22（0.95-1.57）、1.00、0.88（0.72-1.06）、1.02（0.86-1.21）和 1.28（1.07-1.54）的白人糖尿病患者。在非裔美国人和白人糖尿病患者中，基线和随访期间孤立收缩压或舒张压的 U 型关联与中风风险相关。在服用和未服用抗高血压药物的患者中均证实了这种 U 型关联。
目前的研究表明 BP 与中风风险之间存在 U 型关联。在非裔美国人和白人 2 型糖尿病患者中，积极的 BP 控制（<110/65mmHg）和高 BP（≥160/100mmHg）与中风风险增加有关。
