Tanamas Stephanie K, Hanson Robert L, Nelson Robert G, Knowler William C
National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ.
J Diabetes Complications. 2017 Apr;31(4):693-699. doi: 10.1016/j.jdiacomp.2016.12.013. Epub 2017 Jan 20.
Underlying blood pressure is that observed in the absence of antihypertensive treatment or, among those treated, the estimate of that which would be observed without treatment. This study aims to examine the relationships between diabetes or obesity and underlying systolic blood pressure adjusted for antihypertensive treatment by several methods.
Data from two population studies were analyzed-an American Indian community in Arizona and the National Health and Nutrition Examination Surveys. Antihypertensive treatment was accounted for using: no adjustment; antihypertensive use as a covariate; blood pressure dichotomized into normotension and hypertension; addition of a fixed treatment effect; non-parametric algorithm; and censored normal regression.
The magnitude of association at each time point differed by adjustment method particularly where there was a difference in prevalence of antihypertensive use between people with and without diabetes or obesity. The common methods of ignoring antihypertensive treatment or including it as a covariate in a regression model underestimated the effects of diabetes and obesity on underlying blood pressure, compared to the recommended method of the censored normal regression.
Proper accounting for antihypertensive treatment is needed in interpreting variables that affect blood pressure.
基础血压是指在未进行抗高血压治疗时所观察到的血压，或者在接受治疗的人群中，是指未治疗时预计会观察到的血压。本研究旨在通过多种方法研究糖尿病或肥胖与经抗高血压治疗调整后的基础收缩压之间的关系。
对两项人群研究的数据进行了分析，一项是亚利桑那州的一个美国印第安人社区研究，另一项是国家健康与营养检查调查。抗高血压治疗的处理方法如下：不进行调整；将抗高血压药物的使用作为协变量；将血压分为正常血压和高血压；加入固定治疗效应；非参数算法；以及截尾正态回归。
每个时间点的关联程度因调整方法而异，尤其是在糖尿病或肥胖患者与非患者之间抗高血压药物使用患病率存在差异的情况下。与推荐的截尾正态回归方法相比，忽略抗高血压治疗或将其作为回归模型中的协变量这两种常用方法低估了糖尿病和肥胖对基础血压的影响。
在解释影响血压的变量时，需要正确考虑抗高血压治疗。
