Hajebrahimi M A, Akbarpour S, Eslami A, Azizi F, Hadaegh F
Student Research Committee, Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Hum Hypertens. 2017 Nov;31(11):744-749. doi: 10.1038/jhh.2017.49. Epub 2017 Jul 27.
The purpose of this study was to evaluate the effect of combinations of blood pressure and glucose tolerance status on cardiovascular and all-cause mortality. A total of 7619 participants aged ⩾30 years old were stratified to nine categories as follows: (1) normotension (NTN) and normal glucose tolerance (NGT) (reference group), (2) NTN and pre-diabetes mellitus (pre-DM), (3) NTN and DM, (4) pre-hypertension (pre-HTN) and NGT, (5) pre-HTN and pre-DM, (6) pre-HTN and DM, (7) HTN and NGT, (8) HTN and pre-DM and (9) HTN and DM. Cox proportional hazards were applied to calculate the multivariate hazard ratios (HRs) of different groups for outcomes. For all-cause mortality outcomes, prevalent cardiovascular disease (CVD) was also adjusted. In a median follow-up of 11.3 years, 696 CVD and 412 all-cause mortality events occurred. Among the population free from CVD at baseline (n=7249), presence of HTN was associated with increased risk of CVD, regardless of glucose tolerance status with HRs of 1.97 (95% confidence interval (CI), 1.49-2.61), 2.25 (1.68-3.02) and 3.16 (2.28-4.37) for phenotypes of HTN and NGT, HTN and pre-DM and HTN and DM for CVD, respectively; corresponding HRs for all-cause mortality were 1.65 (95% CI, 1.15-2.37), 1.69 (1.15-2.49) and 2.73 (1.80-4.14), respectively. Phenotypes of NTN and pre-DM (1.48; 1.03-2.14) and NTN and DM (2.04; 1.06-3.92) were also associated with CVD and all-cause mortality, respectively. HTN was significantly associated with CVD/mortality events, regardless of glucose tolerance status. Blood pressure <120/80 mm Hg among pre-diabetic/diabetic population, not on antihypertensive medications, was generally associated with worse outcomes.
本研究的目的是评估血压和糖耐量状态组合对心血管疾病和全因死亡率的影响。共有7619名年龄≥30岁的参与者被分为以下九类：(1) 血压正常（NTN）且糖耐量正常（NGT）（参照组），(2) NTN且糖尿病前期（pre-DM），(3) NTN且糖尿病（DM），(4) 高血压前期（pre-HTN）且NGT，(5) pre-HTN且pre-DM，(6) pre-HTN且DM，(7) 高血压（HTN）且NGT，(8) HTN且pre-DM，以及(9) HTN且DM。应用Cox比例风险模型计算不同组结局的多变量风险比（HRs）。对于全因死亡率结局，还对心血管疾病（CVD）的患病率进行了校正。在11.3年的中位随访期内，发生了696例心血管疾病和412例全因死亡事件。在基线时无心血管疾病的人群（n = 7249）中，高血压的存在与心血管疾病风险增加相关，无论糖耐量状态如何，高血压与NGT组、高血压与pre-DM组以及高血压与DM组发生心血管疾病的HR分别为1.97（95%置信区间（CI），1.49 - 2.61）、2.25（1.68 - 3.02）和3.16（2.28 - 4.37）；全因死亡率的相应HR分别为1.65（95% CI，1.15 - 2.37）、1.69（1.15 - 2.49）和2.7
