Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Cardiovascular Center and Cardiology Division, St. Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Int J Cardiol. 2014 Jun 15;174(2):282-7. doi: 10.1016/j.ijcard.2014.04.001. Epub 2014 Apr 12.
Limited data exist regarding the prevalence of coronary artery disease (CAD) as well as clinical outcomes in asymptomatic diabetic patients with normotension, controlled hypertension, and uncontrolled hypertension.
We enrolled 935 consecutive asymptomatic type 2 diabetic patients without known CAD. Coronary computed tomography angiography was used to evaluate the prevalence and severity of CAD. Blood pressure was measured at baseline. Patients were assigned to one of the three groups: normotension (n=314), controlled hypertension (systolic blood pressure (SBP)< 140 mm Hg with treatment, n=458), or uncontrolled hypertension (SBP ≥ 140 mm Hg with or without treatment, n=163).
Obstructive CAD (≥ 50% stenosis) increased from the prevalence in normotensive patients (33%) to that in patients with controlled (40%) or uncontrolled hypertension (52%) (p=0.003). The incidence of obstructive CAD in multivessel or left main CAD also increased across the three groups (13%, 21%, 32%, respectively, p<0.001). A multivariate logistic regression analysis showed that uncontrolled hypertension was an independent predictor of obstructive CAD (adjusted odds ratio, 2.13; 95% confidence interval (CI), 1.42 to 3.21, p<0.001). During a median follow-up of 3.1 years, uncontrolled hypertension was associated with increased risk of cardiac death or myocardial infarction compared to the risk in normotensive patients (hazard ratio, 6.11; 95% CI, 1.65 to 22.6, p=0.007).
In asymptomatic type 2 diabetic patients, uncontrolled hypertension was associated with increased risk of CAD and poor clinical outcomes.
在血压正常、血压得到控制和血压未得到控制的无症状糖尿病伴正常血压、高血压和高血压患者中，关于冠心病（CAD）的患病率以及临床结局的数据有限。
我们纳入了 935 例连续的无症状 2 型糖尿病患者，他们没有已知的 CAD。使用冠状动脉计算机断层血管造影术评估 CAD 的患病率和严重程度。在基线时测量血压。患者被分为三组之一：血压正常（n=314）、血压得到控制（收缩压（SBP）<140mmHg 并接受治疗，n=458）或血压未得到控制（SBP≥140mmHg 并接受或未接受治疗，n=163）。
从血压正常患者（33%）到血压得到控制（40%）或血压未得到控制（52%）的患者中，阻塞性 CAD（≥50%狭窄）的患病率增加（p=0.003）。三组中多支血管或左主干 CAD 的阻塞性 CAD 发生率也增加（分别为 13%、21%和 32%，p<0.001）。多变量逻辑回归分析表明，血压未得到控制是阻塞性 CAD 的独立预测因子（调整后的优势比，2.13；95%置信区间（CI），1.42 至 3.21，p<0.001）。在中位随访 3.1 年期间，与血压正常患者相比，血压未得到控制与心脏死亡或心肌梗死的风险增加相关（危险比，6.11；95%CI，1.65 至 22.6，p=0.007）。
在无症状 2 型糖尿病患者中，血压未得到控制与 CAD 风险增加和临床结局不良相关。
