Department of Internal Medicine 1, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.
PLoS One. 2018 Jul 20;13(7):e0201055. doi: 10.1371/journal.pone.0201055. eCollection 2018.
Hypertension is a risk factor of atherosclerotic diseases. However, the importance of prehypertension in Japanese patients with type 2 diabetes mellitus (T2DM) is controversial. The aim of this study was to examine association between prehypertension, hypertension and atherosclerosis in T2DM.
We recruited 179 Japanese patients with T2DM, who never took any medication for diabetes, hypertension, dyslipidemia, or atherosclerosis. Intima-media thickness (IMT) of common carotid artery was evaluated by high-resolution B-mode ultrasonography.
Multiple regression analysis adjusted for age, duration of diabetes, body mass index, HbA1c, fasting C-peptide, triglyceride, HDL-cholesterol, LDL-cholesterol, and estimated glomerular filtration rate showed that systolic blood pressure (SBP), but not diastolic BP, was significantly and positively associated with maximum IMT (IMT-max), mean IMT, and plaque score (β = 0.28, p<0.001; β = 0.26, p = 0.047; and β = 0.25, p = 0.006, respectively). ROC analysis showed that the cut-off value of SBP to detect atherosclerosis (IMT-max 1.8mm, the mean of IMT-max of this subjects) was 133.5 (p = 0.008), while DBP was not useful to detect it (p = 0.433). Then, participants were categorized as normotension (SBP <119 mmHg), prehypertension (SBP 120-139 mmHg), and hypertension (>140 mmHg). Multiple logistic regression analysis adjusted for the variables described above plus gender and smoking showed that prehypertension and hypertension were significantly associated with the increased risk of atherosclerosis [prehypertension; odds ratio (OR) 3.45, 95% confidence interval (CI) 1.11-10.76, p = 0.033, and hypertension; OR 7.29, 95%CI 1.99-26.78, p = 0.003].
These findings suggest that prehypertension categorized by SBP is an important risk factor of atherosclerosis independently of conventional risk factors in patients with T2DM.
高血压是动脉粥样硬化疾病的一个危险因素。然而，在 2 型糖尿病（T2DM）日本患者中，前期高血压的重要性存在争议。本研究旨在探讨 T2DM 患者中前期高血压、高血压与动脉粥样硬化之间的关系。
我们招募了 179 名从未服用过任何糖尿病、高血压、血脂异常或动脉粥样硬化药物的日本 T2DM 患者。通过高分辨率 B 型超声评估颈总动脉内膜-中层厚度（IMT）。
多变量回归分析调整了年龄、糖尿病病程、体重指数、HbA1c、空腹 C 肽、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和估计肾小球滤过率，结果显示收缩压（SBP），而非舒张压（DBP），与最大 IMT（IMT-max）、平均 IMT 和斑块评分呈显著正相关（β=0.28，p<0.001；β=0.26，p=0.047；β=0.25，p=0.006）。ROC 分析显示，SBP 检测动脉粥样硬化（IMT-max1.8mm，该组 IMT-max 的平均值）的截断值为 133.5mmHg（p=0.008），而 DBP 则不能用于检测（p=0.433）。然后，将参与者分为正常血压（SBP<119mmHg）、前期高血压（SBP120-139mmHg）和高血压（SBP>140mmHg）。多变量 logistic 回归分析调整了上述变量以及性别和吸烟因素，结果表明前期高血压和高血压与动脉粥样硬化的风险增加显著相关[前期高血压；比值比（OR）3.45，95%置信区间（CI）1.11-10.76，p=0.033，高血压；OR7.29，95%CI1.99-26.78，p=0.003]。
这些发现表明，以 SBP 分类的前期高血压是 T2DM 患者中独立于传统危险因素的动脉粥样硬化的重要危险因素。
