Heart and Vascular Center of Excellence, Wake Forest University Baptist Health, Winston-Salem, North Carolina.
Department of Cardiology, Emory University.
J Hypertens. 2018 Jan;36(1):85-92. doi: 10.1097/HJH.0000000000001509.
We examined the associations between blood pressure indices (SBP, DBP, mean arterial pressure and pulse pressure) and cardiovascular disease (CVD) mortality among persons with or without diabetes mellitus (NON-DM) in a multiethnic cohort.
We included 17 650 participants from National Health and Nutrition Examination Survey III and 1439 participants from Diabetes Heart Study (total n = 19 089, 16.3% had diabetes mellitus, mean age 48.5 years, 44.4% white, 27.1% black, 28.5% other race, 54.4% women). Cox proportional hazard, cubic spline and area under the curve analyses were used to assess the associations. CVD death was ascertained via social security registry or the National Death Index.
After a mean (SD) of 16.2 (6.1) years of follow-up, 17.9% of diabetes mellitus and 8.8% of those NON-DM died of CVD. Diabetes mellitus was associated with an increased risk of CVD death [hazard ratio (95% confidence interval): 1.50 (1.25-1.82)]. One SD increase in SBP was significantly associated with CVD mortality in NON-DM [1.28 (1.18-1.39)] but not diabetes mellitus [1.04 (0.88-1.23)] in the full Cox models. Adjusted cubic spline analysis showed significant nonlinear but different association between SBP and CVD mortality among diabetes mellitus (U-shaped) and NON-DM (J-shaped). The C-statistics of our full model in NON-DM and diabetes mellitus were (0.888 vs. 0.735, P < 0.001). SBP showed a trend toward improving C statistics in NON-DM but not diabetes mellitus.
The association between SBP and CVD mortality risk is nonlinear but different in diabetes mellitus (U-shaped) and NON-DM (J-shaped), explaining why aggressive blood pressure lowering may have different outcomes in these two groups.
我们在一个多民族队列中研究了伴有或不伴有糖尿病（NON-DM）的人群中血压指数（SBP、DBP、平均动脉压和脉压）与心血管疾病（CVD）死亡率之间的关联。
我们纳入了来自国家健康和营养检查调查 III 的 17650 名参与者和来自糖尿病心脏研究的 1439 名参与者（总人数为 19089 人，16.3%患有糖尿病，平均年龄为 48.5 岁，44.4%为白人，27.1%为黑人，28.5%为其他种族，54.4%为女性）。使用 Cox 比例风险、三次样条和曲线下面积分析来评估关联。通过社会保障登记处或国家死亡索引确定 CVD 死亡。
在平均（SD）16.2（6.1）年的随访后，17.9%的糖尿病患者和 8.8%的 NON-DM 患者死于 CVD。糖尿病与 CVD 死亡风险增加相关[风险比（95%置信区间）：1.50（1.25-1.82）]。在全 Cox 模型中，SBP 的 1 SD 增加与 NON-DM 患者的 CVD 死亡率显著相关[1.28（1.18-1.39）]，但与糖尿病患者无关[1.04（0.88-1.23）]。调整后的三次样条分析显示，SBP 与 CVD 死亡率之间存在显著的非线性但不同的关联，在糖尿病（U 型）和 NON-DM（J 型）中。我们在 NON-DM 和糖尿病患者中的全模型 C 统计量分别为（0.888 与 0.735，P<0.001）。SBP 在 NON-DM 中显示出改善 C 统计量的趋势，但在糖尿病中没有。
SBP 与 CVD 死亡率风险之间的关联是非线性的，但在糖尿病（U 型）和 NON-DM（J 型）中有所不同，这解释了为什么强化降压在这两组人群中可能有不同的结果。
