From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA.
Neurology. 2019 Mar 12;92(11):e1168-e1175. doi: 10.1212/WNL.0000000000007093. Epub 2019 Feb 8.
To determine whether higher blood pressure mean (BPM) or hemoglobin A1c is associated with progression of white matter hyperintensity (WMH) on MRI in patients with type 2 diabetes, and whether intensive blood pressure or glycemic control can reduce that progression.
We performed a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD MIND) research materials. The primary outcome is change in WMH volume (ΔWMH) between a baseline and month-40 MRI, and the primary predictor is BPM and A1c between the MRIs. Additional analyses compared ΔWMH in the intensive vs standard glycemic control randomization arms (n = 502) and intensive vs standard blood pressure control randomization arms (n = 314).
Higher systolic BPM, but not diastolic BPM or A1c, was associated with WMH progression. The ΔWMH in tertiles of increasing systolic BPM (115 ± 4, 127 ± 3, and 139 ± 6 mm Hg) was 0.7, 0.9, and 1.2 cm ( < 0.001). ΔWMH was lower in the intensive vs standard blood pressure control randomization arm (ΔWMH = 0.67 ± 0.95 vs 1.16 ± 1.13 cm, < 0.001), but there was no difference in the glycemic control arms ( = 0.917).
In ACCORD MIND, higher systolic blood pressure was associated with WMH progression. The intensive blood pressure control intervention reduced this progression. Comorbid diabetes and hypertension has synergistic deleterious properties that increase the risk of micro- and macrovascular complications. These results provide further support for an aggressive approach to blood pressure control in type 2 diabetics.
确定 2 型糖尿病患者的平均血压（BPM）或糖化血红蛋白（A1c）升高与 MRI 上的脑白质高信号（WMH）进展是否相关，以及强化血压或血糖控制是否可以降低这种进展。
我们对心血管风险控制行动在糖尿病记忆中的研究材料（ACCORD MIND）进行了二次分析。主要结果是基线和第 40 个月 MRI 之间的 WMH 体积变化（ΔWMH），主要预测指标是 MRI 之间的 BPM 和 A1c。额外的分析比较了强化与标准血糖控制随机分组臂（n = 502）和强化与标准血压控制随机分组臂（n = 314）之间的ΔWMH。
较高的收缩压 BPM，但不是舒张压 BPM 或 A1c，与 WMH 进展相关。收缩压 BPM 递增三分位组（115 ± 4、127 ± 3 和 139 ± 6 mmHg）的ΔWMH 分别为 0.7、0.9 和 1.2 cm（<0.001）。强化与标准血压控制随机分组臂之间的ΔWMH 较低（ΔWMH = 0.67 ± 0.95 与 1.16 ± 1.13 cm，<0.001），但血糖控制组之间没有差异（= 0.917）。
在 ACCORD MIND 中，较高的收缩压与 WMH 进展相关。强化血压控制干预减少了这种进展。合并糖尿病和高血压具有协同的有害特性，增加了微血管和大血管并发症的风险。这些结果为 2 型糖尿病患者积极控制血压提供了进一步的支持。
