From the Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan.
Hypertension. 2018 Aug;72(2):323-330. doi: 10.1161/HYPERTENSIONAHA.118.11408. Epub 2018 Jul 2.
This study aimed to assess whether intensive blood pressure (BP) treatment has benefits in preventing cardiovascular events, including heart failure in patients with type 2 diabetes mellitus. Using the ACCORD BP trial (Action to Control Cardiovascular Risk in Diabetes Blood Pressure) data, hazard ratios for cardiovascular events with 95% confidence intervals were calculated using the Cox proportional hazard models to compare the time to the first cardiovascular event in patients receiving standard (n=2362) or intensive glycemic control (n=2371). The overall mean follow-up period was 4.5 years, and cardiovascular events were confirmed in 528 patients. The cardiovascular event risk in patients receiving standard glycemic control was significantly lower in the intensive BP treatment group than in the standard BP treatment group (hazard ratio, 0.71; 95% confidence interval, 0.56-0.90; =0.005), whereas that in patients receiving intensive glycemic control did not differ significantly between the groups (hazard ratio, 1.06; 95% confidence interval, 0.83-1.36; =0.61). There was a significant interaction between the BP treatment strategy and glycemic control (=0.02). The stroke risk in patients receiving standard glycemic control was significantly lower in the intensive BP treatment group, but not in patients receiving intensive glycemic control. Although not significant, all-cause mortality in patients receiving intensive glycemic control was higher in patients receiving intensive BP treatment than in those receiving standard BP treatment (hazard ratio, 1.38; 95% confidence interval, 0.99-1.92; =0.05). Benefits of intensive BP treatment were observed only in ACCORD BP participants receiving standard glycemic control without additional risk factors.
本研究旨在评估强化血压（BP）治疗是否有益于预防心血管事件，包括 2 型糖尿病患者的心力衰竭。使用 ACCORD BP 试验（控制心血管风险中的行动糖尿病血压）数据，使用 Cox 比例风险模型计算心血管事件的风险比及其 95%置信区间，以比较接受标准（n=2362）或强化血糖控制（n=2371）的患者发生首次心血管事件的时间。总的平均随访期为 4.5 年，有 528 例患者发生心血管事件。接受标准血糖控制的患者在强化 BP 治疗组的心血管事件风险明显低于标准 BP 治疗组（风险比，0.71；95%置信区间，0.56-0.90；=0.005），而接受强化血糖控制的患者在两组之间无显著差异（风险比，1.06；95%置信区间，0.83-1.36；=0.61）。BP 治疗策略和血糖控制之间存在显著交互作用（=0.02）。接受标准血糖控制的患者在强化 BP 治疗组的中风风险明显降低，但在接受强化血糖控制的患者中则没有。尽管不显著，但接受强化血糖控制的患者的全因死亡率在接受强化 BP 治疗的患者中高于接受标准 BP 治疗的患者（风险比，1.38；95%置信区间，0.99-1.92；=0.05）。强化 BP 治疗的益处仅见于接受标准血糖控制且无其他危险因素的 ACCORD BP 参与者中。
