2型糖尿病患者预防糖尿病肾病进展的最佳家庭收缩压目标
Optimal home SBP targets for preventing the progression of diabetic nephropathy in patients with type 2 diabetes mellitus.
作者信息
Ushigome Emi, Hamaguchi Masahide, Matsumoto Shinobu, Oyabu Chikako, Omoto Atsushi, Tanaka Toru, Fukuda Wataru, Hasegawa Goji, Mogami Shin-ichi, Ohnishi Masayoshi, Kitagawa Yoshihiro, Tsunoda Sei, Oda Yohei, Nakamura Naoto, Fukui Michiaki
机构信息
aDepartment of Endocrinology and Metabolism, Kyoto Prefectural University, of Medicine, Graduate School of Medical Science bDepartment of Endocrinology and Metabolism, Kyoto First Red Cross Hospital cDepartment of Endocrinology and Metabolism, Kyoto Second Red Cross Hospital, Kyoto dDepartment of Endocrinology and Metabolism, Osaka General Hospital of West Japan Railway Company, Osaka eDepartment of Cardiology, Nishijin Hospital, Kyoto, Japan.
出版信息
J Hypertens. 2015 Sep;33(9):1853-9; discussion 1859. doi: 10.1097/HJH.0000000000000636.
OBJECTIVES
Home blood pressure control can reduce the risk of increased urinary albumin excretion in patients with diabetes mellitus. However, the optimal home blood pressure targets to prevent the onset or progression of diabetic nephropathy are not well defined.
METHODS
We performed a retrospective cohort study of 851 patients with type 2 diabetes mellitus. Logistic regression models were used to evaluate the correlations of home SBP levels with progression of diabetic nephropathy.
RESULTS
During the follow-up of 2 years, 86 patients had progression of diabetic nephropathy. Adjusted odds ratios (95% confidence interval) for progression of diabetic nephropathy in patients with morning SBP of 120-129 mmHg [2.725 (1.074-6.917), P = 0.035], 130-139 mmHg [3.703 (1.519-9.031), P = 0.004] and in those with morning SBP equal or more than 140 mmHg [2.994 (1.182-7.581), P = 0.021] were significantly higher than that in those with morning SBP less than 120 mmHg in multiple logistic analyses.
CONCLUSION
The preferable morning SBP targets might be less than 120 mmHg for preventing the onset or progression of diabetic nephropathy in patients with type 2 diabetes mellitus.
目的
家庭血压控制可降低糖尿病患者尿白蛋白排泄增加的风险。然而，预防糖尿病肾病发生或进展的最佳家庭血压目标尚未明确界定。
方法
我们对851例2型糖尿病患者进行了一项回顾性队列研究。采用逻辑回归模型评估家庭收缩压水平与糖尿病肾病进展的相关性。
结果
在2年的随访期间，86例患者出现糖尿病肾病进展。在多因素逻辑分析中，早晨收缩压为120 - 129 mmHg的患者糖尿病肾病进展的校正比值比（95%置信区间）为[2.725(1.074 - 6.917)，P = 0.035]，130 - 139 mmHg的患者为[3.703(1.519 - 9.031)，P = 0.004]，早晨收缩压等于或高于140 mmHg的患者为[2.994(1.182 - 7.581)，P = 0.021]，均显著高于早晨收缩压低于120 mmHg 的患者。
结论
对于预防2型糖尿病患者糖尿病肾病的发生或进展，较为理想的早晨收缩压目标可能低于120 mmHg。
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