血压变异性对 2 型糖尿病患者大血管和微血管并发症的影响： ADVANCE 试验。
Effects of visit-to-visit variability in systolic blood pressure on macrovascular and microvascular complications in patients with type 2 diabetes mellitus: the ADVANCE trial.
机构信息
From The George Institute for Global Health, University of Sydney, Sydney, Australia (J.H., H.A., M.W., S.Z., C.A., A.P., B.N., S.M., J.C.); University of Oxford, Oxford, United Kingdom (P.M.R., S.M.); School of Public Health, Monash University, Clayton, Australia (S.Z.); Bond University, Gold Coast, Australia (P.G.); Université de Montréal, Montreal, Canada (P.H.); University of Milan-Bicocca, Milan, Italy (G.M.); Imperial College, London, United Kingdom (N.P.); and University College London (UCL) and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, United Kingdom (B.W.).
出版信息
Circulation. 2013 Sep 17;128(12):1325-34. doi: 10.1161/CIRCULATIONAHA.113.002717. Epub 2013 Aug 7.
BACKGROUND
Recent evidence suggests that visit-to-visit variability in systolic blood pressure (SBP) and maximum SBP are predictors of cardiovascular disease. However, it remains uncertain whether these parameters predict the risks of macrovascular and microvascular complications in patients with type 2 diabetes mellitus.
METHODS AND RESULTS
The Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) was a factorial randomized controlled trial of blood pressure lowering and blood glucose control in patients with type 2 diabetes mellitus. The present analysis included 8811 patients without major macrovascular and microvascular events or death during the first 24 months after randomization. SBP variability (defined as standard deviation) and maximum SBP were determined during the first 24 months after randomization. During a median 2.4 years of follow-up from the 24-month visit, 407 major macrovascular (myocardial infarction, stroke, or cardiovascular death) and 476 microvascular (new or worsening nephropathy or retinopathy) events were observed. The association of major macrovascular and microvascular events with SBP variability was continuous even after adjustment for mean SBP and other confounding factors (both P<0.05 for trend). Hazard ratios (95% confidence intervals) for the highest tenth of SBP variability were 1.54 (0.99-2.39) for macrovascular events and 1.84 (1.19-2.84) for microvascular events in comparison with the lowest tenth. For maximum SBP, hazard ratios (95% confidence intervals) for the highest tenth were 3.64 (1.73-7.66) and 2.18 (1.04-4.58), respectively.
CONCLUSION
Visit-to-visit variability in SBP and maximum SBP were independent risk factors for macrovascular and microvascular complications in type 2 diabetes mellitus.
CLINICAL TRIAL REGISTRATION URL
背景
最近的证据表明，收缩压（SBP）和最大 SBP 的随访间变异性是心血管疾病的预测因子。然而，这些参数是否预测 2 型糖尿病患者大血管和微血管并发症的风险仍不确定。
方法和结果
糖尿病和血管疾病行动：培哚普利氨氯地平与贝那普利随机对照评估（ADVANCE）是一项降压和血糖控制的 2 型糖尿病患者的因子随机对照试验。本分析包括 8811 例患者，在随机分组后 24 个月内没有发生重大大血管和微血管事件或死亡。在随机分组后 24 个月内确定 SBP 变异性（定义为标准差）和最大 SBP。在 24 个月访视后的中位 2.4 年随访期间，观察到 407 例主要大血管（心肌梗死、卒中和心血管死亡）和 476 例微血管（新发或恶化的肾病或视网膜病变）事件。即使在调整平均 SBP 和其他混杂因素后，大血管和微血管事件与 SBP 变异性的关联仍然是连续的（趋势 P<0.05）。SBP 变异性最高十分位的危险比（95%置信区间）分别为大血管事件 1.54（0.99-2.39）和微血管事件 1.84（1.19-2.84）与最低十分位相比。对于最大 SBP，最高十分位的危险比（95%置信区间）分别为 3.64（1.73-7.66）和 2.18（1.04-4.58）。
结论
SBP 和最大 SBP 的随访间变异性是 2 型糖尿病大血管和微血管并发症的独立危险因素。
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