van Hateren Kornelis J J, Hendriks Steven H, Groenier Klaas H, Bakker Stephan J L, Bilo Henk J G, Kleefstra Nanne, Landman Gijs W D
aDiabetes Centre, Isala, Zwolle bDepartment of General Practice cDepartment of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen dDepartment of Internal Medicine, Isala eLangerhans Medical Research Group, Zwolle fDepartment of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands.
J Hypertens. 2015 Jun;33(6):1162-6. doi: 10.1097/HJH.0000000000000555.
We aimed to investigate whether adjustment for frailty influences the relationship of blood pressure with mortality in elderly patients with type 2 diabetes mellitus (T2DM).
Patients aged 60 years and older (n = 858) were selected from a prospective observational cohort study of primary care patients with T2DM. Frailty was defined as a score less than 80 on the subscale 'physical functioning' of the RAND-36 questionnaire. After median follow-up for 14 years, multivariate Cox regression analyses were performed to evaluate the association between blood pressure and (cardiovascular) mortality. Analyses were performed in strata according to the frailty level ('physical functioning' score <80 and ≥80) and were repeated for patients older than 75 years.
Frailty was highly prevalent in our study population; 629 out of 858 patients (73%) fulfilled the criterion. For patients aged at least 60 years, the hazard ratios (95% confidence interval) of a 10 mmHg increase in SBP and DBP for cardiovascular mortality in nonfrail patients were 1.38 (1.15-1.68%) and 1.60 (1.07-2.37%), respectively. No relationship was observed for frail patients. For the oldest frail elderly, the hazard ratios of SBP and DBP for all-cause mortality were 0.92 (0.87-0.98%) and 0.83 (0.73-0.93%), respectively. For the oldest nonfrail elderly, a positive relationship between SBP and all-cause mortality was observed.
Frailty modifies the relationship between blood pressure and mortality in elderly patients with T2DM. Higher blood pressure was related to increased cardiovascular mortality in nonfrail patients, even in the oldest elderly, and to lower all-cause mortality in frail patients.
我们旨在研究对虚弱进行校正是否会影响老年2型糖尿病（T2DM）患者血压与死亡率之间的关系。
从一项针对T2DM初级保健患者的前瞻性观察队列研究中选取60岁及以上的患者（n = 858）。虚弱定义为在兰德36项问卷的“身体功能”子量表上得分低于80分。在进行了14年的中位随访后，进行多变量Cox回归分析以评估血压与（心血管）死亡率之间的关联。根据虚弱水平（“身体功能”得分<80和≥80）分层进行分析，并对75岁以上的患者重复进行分析。
虚弱在我们的研究人群中非常普遍；858名患者中有629名（73%）符合标准。对于至少60岁的患者，非虚弱患者收缩压（SBP）和舒张压（DBP）每升高10 mmHg时心血管死亡的风险比（95%置信区间）分别为1.38（1.15 - 1.68%）和1.60（1.07 - 2.37%）。虚弱患者未观察到相关性。对于最年长的虚弱老年人，SBP和DBP全因死亡的风险比分别为0.92（0.87 - 0.98%）和0.83（0.73 - 0.93%）。对于最年长的非虚弱老年人，观察到SBP与全因死亡率之间存在正相关。
虚弱改变了老年T2DM患者血压与死亡率之间的关系。较高的血压与非虚弱患者心血管死亡率增加相关，即使在最年长的老年人中也是如此，而与虚弱患者较低的全因死亡率相关。
