Fink Jennifer T, Magnan Elizabeth M, Johnson Heather M, Bednarz Lauren M, Allen Glenn O, Greenlee Robert T, Bolt Daniel M, Smith Maureen A
Department of Health Informatics and Administration, College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
Aurora Research Institute, Aurora Health Care, Milwaukee, WI, USA.
High Blood Press Cardiovasc Prev. 2018 Dec;25(4):391-399. doi: 10.1007/s40292-018-0284-x. Epub 2018 Oct 16.
There are no population-level estimates in the United States for achievement of blood pressure goals in patients with diabetes and hypertension by obesity weight class.
We sought to examine the relationship between the extent of obesity and the achievement of guideline-recommended blood pressure goals and other quality of care metrics among patients with diabetes.
We conducted an observational population-based cohort study of electronic health data of three large health systems from 2010-2012 in rural, urban and suburban settings of 51,229 adults with diabetes. Outcomes were achievement of diabetes quality of care metrics: blood pressure, A1c, and LDL control, and A1c and LDL testing. Two blood pressure goals were examined given the recommendation for adults with diabetes of 130/80 mmHg from JNC7 and the recommendation of 140/90 mmHg from JNC8 in 2014.
Patients in obesity classes I, II, and III with diagnosed hypertension were less likely to achieve blood pressure control at both the 140/90 mmHg and 130/80 mmHg control levels. The patients from obesity class III had the lowest likelihood of achieving control at the 130/80 mmHg goal, and control was markedly worse for the 130/80 mmHg threshold in all weight classes. There were minimal to no differences by weight class in LDL and A1c control and LDL and A1c testing.
Although the cardiovascular risk for patients with obesity and diabetes is greater than for non-obese patients with diabetes, we found that patients with obesity are even further behind in achieving blood pressure control.
在美国，尚无按肥胖体重类别划分的糖尿病合并高血压患者血压达标情况的总体估计数据。
我们试图研究肥胖程度与糖尿病患者指南推荐的血压目标达成情况以及其他医疗质量指标之间的关系。
我们对2010 - 2012年来自三个大型医疗系统的电子健康数据进行了一项基于人群的观察性队列研究，研究对象为51,229名农村、城市和郊区的成年糖尿病患者。结局指标为糖尿病医疗质量指标的达成情况：血压、糖化血红蛋白（A1c）和低密度脂蛋白（LDL）控制情况，以及A1c和LDL检测情况。鉴于美国国立卫生研究院第七次报告（JNC7）对糖尿病成年人的血压推荐为130/80 mmHg，以及2014年美国国立卫生研究院第八次报告（JNC8）的推荐为140/90 mmHg，我们对两个血压目标进行了研究。
患有确诊高血压的I、II和III级肥胖患者在140/90 mmHg和130/80 mmHg控制水平上实现血压控制的可能性较小。III级肥胖患者在130/80 mmHg目标下实现控制的可能性最低，并且在所有体重类别中，130/80 mmHg阈值的控制情况明显更差。在LDL和A1c控制以及LDL和A1c检测方面，体重类别之间的差异极小或不存在差异。
尽管肥胖糖尿病患者的心血管风险高于非肥胖糖尿病患者，但我们发现肥胖患者在实现血压控制方面甚至更为落后。
