From the Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital (M.K.K., H.-S.K.), College of Medicine, Catholic University of Korea, Seoul.
Department of Medical Statistics (K.H.), College of Medicine, Catholic University of Korea, Seoul.
Hypertension. 2019 Feb;73(2):319-326.
The objective of this study was to investigate the optimal blood pressure (BP) target to prevent development of cardiovascular diseases (CVDs) in Korean subjects with type 2 diabetes mellitus. Using the Korean National Health Insurance Service database, 2 262 725 subjects with type 2 diabetes mellitus who underwent regular health checks between 2009 and 2012 were included. Subjects with previous CVDs were excluded. Participants were grouped by 10-mm Hg intervals of observed systolic BP (SBP) by 5-mm Hg intervals of diastolic BP. There were 124 466 deaths (5.50%), 67 235 cases of stroke (2.97%), and 41 726 myocardial infarctions (1.84%) during a median follow-up of 6.5 years. Compared with SBP 110 to 119 mm Hg, there was no increased risk among subjects with SBP 120 to 129 mm Hg, but SBP ≥130 mm Hg was associated with a significant increase in the incidence of CVDs. SBP 130 to 139 mm Hg was associated with a significant increase in the incidence of stroke (hazard ratio, 1.15; 95% CI, 1.12-1.18) and myocardial infarctions (hazard ratio, 1.05; 95% CI, 1.02-1.09) compared with SBP 110 to 119 mm Hg. Subjects with diastolic BP 80 to 84 mm Hg had a higher risk of CVDs than subjects with diastolic BP 75 to 79 mm Hg. The overall relationship between BP and CVD risk was positive, with a greater strength observed for younger age groups. The optimal cutoff for Korean patients with type 2 diabetes mellitus associated with lower CVD risk may be 130 mm Hg for SBP or 80 mm Hg for diastolic BP.
本研究旨在探讨预防韩国 2 型糖尿病患者发生心血管疾病（CVD）的最佳血压（BP）目标。利用韩国国家健康保险服务数据库，纳入了 2009 年至 2012 年间接受定期健康检查的 2262725 例 2 型糖尿病患者。排除了既往有 CVD 的患者。根据观察到的收缩压（SBP）每 10mmHg 的间隔和舒张压（DBP）每 5mmHg 的间隔，将参与者分为 124466 例死亡（5.50%）、67235 例卒中（2.97%）和 41726 例心肌梗死（1.84%）。中位随访 6.5 年后，与 SBP 110-119mmHg 相比，SBP 120-129mmHg 之间的风险无增加，但 SBP≥130mmHg 与 CVD 发生率的显著增加相关。SBP 130-139mmHg 与卒中（危险比，1.15；95%置信区间，1.12-1.18）和心肌梗死（危险比，1.05；95%置信区间，1.02-1.09）的发生率显著增加相关。与 SBP 110-119mmHg 相比，DBP 80-84mmHg 的患者 CVD 风险更高。BP 与 CVD 风险之间的总体关系呈阳性，在年龄较小的人群中观察到更强的相关性。与较低 CVD 风险相关的韩国 2 型糖尿病患者的最佳 BP 截断值可能为 SBP 130mmHg 或 DBP 80mmHg。
