Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Department of Internal Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden.
Cardiovasc Diabetol. 2020 Oct 12;19(1):175. doi: 10.1186/s12933-020-01150-0.
The relationship between blood pressure and mortality in type 2 diabetes (T2DM) is controversial, with concern for increased risk associated with excessively lowered blood pressure.
We evaluated whether prior cardiovascular disease (CVD) altered the relationship between baseline blood pressure and all-cause mortality in 5852 patients with T2DM and a recent acute coronary syndrome (ACS) who participated in the ELIXA (Evaluation of Lixisenatide in Acute Coronary Syndrome) trial. Risk of death was assessed in Cox models adjusted for age, sex, race, heart rate, BMI, smoking, diabetes duration, insulin use, HbA1c, eGFR, brain natriuretic peptide (BNP), urine albumin/creatinine ratio, treatment allocation and prior coronary revascularization.
Although overall there was no significant association between systolic blood pressure (SBP) and mortality (hazard ratio per 10 mmHg lower SBP 1.05 (95% CI 0.99-1.12) P = 0.10), lower SBP was significantly associated with higher risk of death (hazard ratio per 10 mmHg lower SBP 1.13 (95% CI 1.04-1.22) P = 0.002) in 2325 patients with additional CVD (index ACS+ at least one of the following prior to randomization: myocardial infarction other than the index ACS, stroke or heart failure). In 3527 patients with only the index ACS no significant association was observed (hazard ratio per 10 mmHg lower SBP 0.95 (0.86-1.04) P = 0.26; P for interaction 0.005).
The association between blood pressure and mortality was modified by additional CVD history in patients with type 2 diabetes and a recent coronary event. When blood pressures measured after an acute coronary event are used to assess the risk of death in patients with type 2 diabetes, the cardiovascular history needs to be taken into consideration. Trial registration ClinicalTrials.gov number NCT01147250, first posted June 22, 2010.
2 型糖尿病（T2DM）患者的血压与死亡率之间的关系存在争议，人们担心血压过低会增加风险。
我们评估了在最近发生急性冠状动脉综合征（ACS）的 5852 例 T2DM 患者中，既往心血管疾病（CVD）是否改变了基线血压与全因死亡率之间的关系，这些患者参加了 ELIXA（Lixisenatide 在急性冠状动脉综合征中的评估）试验。使用 Cox 模型评估死亡率，该模型调整了年龄、性别、种族、心率、BMI、吸烟、糖尿病病程、胰岛素使用、HbA1c、eGFR、脑钠肽（BNP）、尿白蛋白/肌酐比值、治疗分配和既往冠状动脉血运重建。
尽管总体而言，收缩压（SBP）与死亡率之间无显著相关性（每降低 10mmHg 的 SBP 风险比为 1.05（95%CI 0.99-1.12），P=0.10），但较低的 SBP 与更高的死亡风险显著相关（每降低 10mmHg 的 SBP 风险比为 1.13（95%CI 1.04-1.22），P=0.002），这在 2325 例有额外 CVD 的患者中更为明显（指数 ACS+随机化前至少有一种以下疾病：除指数 ACS 以外的心肌梗死、卒中和心力衰竭）。在 3527 例仅有指数 ACS 的患者中，未观察到显著相关性（每降低 10mmHg 的 SBP 的风险比为 0.95（0.86-1.04），P=0.26；P 交互作用值为 0.005）。
在近期发生冠状动脉事件的 2 型糖尿病患者中，血压与死亡率之间的关系受额外 CVD 病史的影响。当使用急性冠状动脉事件后的血压评估 2 型糖尿病患者的死亡风险时，需要考虑心血管病史。
试验注册ClinicalTrials.gov 编号：NCT01147250，首次注册日期：2010 年 6 月 22 日。
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