Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
Hypertens Res. 2018 Jul;41(7):531-538. doi: 10.1038/s41440-018-0042-4. Epub 2018 Apr 13.
Diabetes mellitus is characterized by alterations in blood glucose (BG) metabolism, and glycated hemoglobin (HbAc) has been widely used as a marker of the BG concentration. Diabetes often coexists with high blood pressure (BP). High BP and hyperglycemia are well-known risk factors of stroke. We examined the extent to which the increased risk of stroke in diabetic individuals is attributable to BP and BG using prospectively collected data from the Japanese general population. During an average 8.3 ± 2.2 years of follow-up, out 1606 diabetic individuals aged ≥40 years who were free of cardiovascular disease, 119 participants (7.4%) developed stroke. In multivariable analysis, a significant difference in the risk of incident stroke was noted among the BP categories, including normotension (BP1), prehypertension (BP2), and hypertension (BP3; P for trend = 0.001). By contrast, no difference was noted among the BG categories, including HbAc levels <7.0% (HB1), 7.0-7.9% (HB2), and ≥8.0% (HB3; P for trend = 0.430). Compared with the category that included both BP1 and HB1, the population-attributable fraction (PAF) for stroke incidence was 52.0% from the BP2 and BP3 categories and 24.1% from the HB2 and HB3 categories, and the increased incidence from the HB2 and HB3 categories was mostly caused from coexistent BP2 and BP3 categories. In conclusion, in the Japanese community-based diabetic population, concomitant BP elevation largely contributes to the increased incidence of stroke and links BG elevation, as indicated by HbAc, to the increased risk of stroke.
糖尿病的特征是血糖（BG）代谢的改变，糖化血红蛋白（HbAc）已被广泛用作 BG 浓度的标志物。糖尿病常伴有高血压（BP）。高血压和高血糖是众所周知的中风危险因素。我们使用日本一般人群中前瞻性收集的数据，检查了糖尿病患者中风风险增加在多大程度上归因于 BP 和 BG。在平均 8.3±2.2 年的随访期间，在 1606 名年龄≥40 岁且无心血管疾病的糖尿病患者中，有 119 名（7.4%）发生中风。在多变量分析中，在 BP 类别中观察到中风事件风险的显著差异，包括正常血压（BP1）、高血压前期（BP2）和高血压（BP3；趋势 P 值=0.001）。相比之下，在 BG 类别中没有观察到差异，包括 HbAc 水平<7.0%（HB1）、7.0-7.9%（HB2）和≥8.0%（HB3；趋势 P 值=0.430）。与包括 BP1 和 HB1 的类别相比，BP2 和 BP3 类别中风发病率的人群归因分数（PAF）为 52.0%，HB2 和 HB3 类别为 24.1%，HB2 和 HB3 类别发病率的增加主要是由共存的 BP2 和 BP3 类别引起的。总之，在日本社区糖尿病人群中，同时存在的 BP 升高在很大程度上导致中风发病率的增加，并且 HbAc 所示的 BG 升高与中风风险的增加相关。
