在已确诊的高血压患者中，糖尿病与血压控制不佳之间的关联在墨西哥裔美国人和黑人中是否比在白人中更强？
Is the association of diabetes with uncontrolled blood pressure stronger in Mexican Americans and blacks than in whites among diagnosed hypertensive patients?
作者信息
Liu Xuefeng, Song Ping
机构信息
Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee;
Department of Internal Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
出版信息
Am J Hypertens. 2013 Nov;26(11):1328-34. doi: 10.1093/ajh/hpt109. Epub 2013 Jul 17.
BACKGROUND
Clinical evidence shows that diabetes may provoke uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of diabetes with uncontrolled BP outcomes among diagnosed hypertensive patients have not been evaluated.
METHODS
A total of 6,134 diagnosed hypertensive subjects aged ≥ 20 years were collected from the National Health and Nutrition Examination Survey 1999-2008 with a stratified multistage design. Odds ratios (ORs) and relative ORs of uncontrolled BP and effect differences in continuous BP for diabetes over race/ethnicity were derived using weighted logistic regression and linear regression models.
RESULTS
Compared with participants who did not have diabetes, non-Hispanic black participants with diabetes had a 138% higher chance of having uncontrolled BP, Mexican participants with diabetes had a 60% higher chance of having uncontrolled BP, and non-Hispanic white participants with diabetes had a 161% higher chances of having uncontrolled BP. The association of diabetes with uncontrolled BP was lower in Mexican Americans than in non-Hispanic blacks and whites (Mexican Americans vs. non-Hispanic blacks: relative OR = 0.55, 95% confidence interval (CI) = 0.37-0.82; Mexican Americans vs. non-Hispanic whites: relative OR = 0.53, 95% CI = 0.35-0.80) and the association of diabetes with isolated uncontrolled systolic BP was lower in Mexican Americans than in non-Hispanic whites (Mexican Americans vs. non-Hispanic whites: relative OR = 0.62, 95% CI = 0.40-0.96). Mexican Americans have a stronger association of diabetes with decreased systolic BP and diastolic BP than non-Hispanic whites, and a stronger association of diabetes with decreased diastolic BP than non-Hispanic blacks.
CONCLUSIONS
The association of diabetes with uncontrolled BP outcomes is lower despite higher prevalence of diabetes in Mexican Americans than in non-Hispanic whites. The stronger association of diabetes with BP outcomes in whites should be of clinical concern, considering they account for the majority of the hypertensive population in the United States.
背景
临床证据表明，糖尿病可能会导致高血压患者血压失控。然而，尚未评估确诊高血压患者中糖尿病与血压失控结局之间关联的种族差异。
方法
采用分层多阶段设计，从1999 - 2008年国家健康与营养检查调查中收集了总共6134名年龄≥20岁的确诊高血压受试者。使用加权逻辑回归和线性回归模型得出糖尿病在不同种族/族裔中血压失控的比值比（OR）和相对OR，以及连续血压的效应差异。
结果
与未患糖尿病的参与者相比，患有糖尿病的非西班牙裔黑人参与者血压失控的几率高138%，患有糖尿病的墨西哥裔参与者血压失控的几率高60%，患有糖尿病的非西班牙裔白人参与者血压失控的几率高161%。墨西哥裔美国人中糖尿病与血压失控的关联低于非西班牙裔黑人和白人（墨西哥裔美国人与非西班牙裔黑人：相对OR = 0.55，95%置信区间（CI）= 0.37 - 0.82；墨西哥裔美国人与非西班牙裔白人：相对OR = 0.53，95% CI = 0.35 - 0.80），且墨西哥裔美国人中糖尿病与单纯收缩压失控的关联低于非西班牙裔白人（墨西哥裔美国人与非西班牙裔白人：相对OR = 0.62，95% CI = 0.40 - 0.96）。与非西班牙裔白人相比，墨西哥裔美国人中糖尿病与收缩压和舒张压降低的关联更强，且与非西班牙裔黑人相比，糖尿病与舒张压降低的关联更强。
结论
尽管墨西哥裔美国人中糖尿病的患病率高于非西班牙裔白人，但糖尿病与血压失控结局的关联较低。考虑到白人占美国高血压人群的大多数，糖尿病与白人血压结局更强的关联应引起临床关注。
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