Kim Hack-Lyoung, Kim Hyue Mee, Kwon Chang Hee, Shin Jeong-Hun, Jung Mi-Hyang, Lee Chan Joo, Kim Dae-Hee, Kim Woo-Hyeun, Kang Si-Hyuck, Lee Ju-Hee, Cho In Jeong, Cho Iksung, Lee Jun Hyeok, Kang Dae Ryong, Lee Hae-Young, Chung Wook-Jin, Ihm Sang-Hyun, Kim Kwang Il, Cho Eun Joo, Sohn Il-Suk, Kim Hyeon-Chang, Shin Jinho, Kim Ju Han, Ryu Sung Kee, Kang Seok-Min, Pyun Wook Bum, Cho Myeong-Chan, Park Sungha, Sung Ki-Chul
Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University, Seoul, Republic of Korea.
Cardiovasc Diabetol. 2020 Oct 19;19(1):181. doi: 10.1186/s12933-020-01156-8.
Little is known about age-specific target blood pressure (BP) in hypertensive patients with diabetes mellitus (DM). The aim of this study was to determine the BP level at the lowest cardiovascular risk of hypertensive patients with DM according to age.
Using the Korean National Health Insurance Service database, we analyzed patients without cardiovascular disease diagnosed with both hypertension and DM from January 2002 to December 2011. Primary end-point was composite cardiovascular events including cardiovascular death, myocardial infarction and stroke.
Of 241,148 study patients, 35,396 had cardiovascular events during a median follow-up period of 10 years. At the age of < 70 years, the risk of cardiovascular events was lower in patients with BP < 120/70 mmHg than in those with BP 130-139/80-89 mmHg. At the age of ≥ 70, however, there were no significant differences in the risk of cardiovascular events between patients with BP 130-139/80-89 mmHg and BP < 120/70 mmHg. The risk of cardiovascular events was similar between patients with BP 130-139/80-89 mmHg and BP 120-129/70-79 mmHg, and it was significantly higher in those with BP ≥ 140/90 mmHg than in those with BP 130-139/80-89 mmHg at all ages.
In a cohort of hypertensive patients who had DM but no history of cardiovascular disease, lower BP was associated with lower risk of cardiovascular events especially at the age of < 70. However, low BP < 130-139/80-89 mmHg was not associated with decreased cardiovascular risk, it may be better to keep the BP of 130-139/80-89 mmHg at the age of ≥ 70.
关于糖尿病（DM）合并高血压患者的特定年龄目标血压（BP），我们所知甚少。本研究的目的是根据年龄确定DM合并高血压患者心血管风险最低时的血压水平。
利用韩国国民健康保险服务数据库，我们分析了2002年1月至2011年12月期间诊断为高血压和DM且无心血管疾病的患者。主要终点是包括心血管死亡、心肌梗死和中风在内的复合心血管事件。
在241,148例研究患者中，在中位随访期10年期间，有35,396例发生心血管事件。在年龄＜70岁时，血压＜120/70 mmHg的患者心血管事件风险低于血压为130 - 139/80 - 89 mmHg的患者。然而，在年龄≥70岁时，血压为130 - 139/80 - 89 mmHg的患者与血压＜120/70 mmHg的患者之间，心血管事件风险无显著差异。血压为130 - 139/80 - 89 mmHg的患者与血压为120 - 129/70 - 79 mmHg的患者之间，心血管事件风险相似，且在所有年龄段，血压≥140/90 mmHg的患者心血管事件风险显著高于血压为130 - 139/80 - 89 mmHg的患者。
在一组患有DM但无心血管疾病史的高血压患者中，较低的血压与较低的心血管事件风险相关，尤其是在年龄＜70岁时。然而，血压＜130 - 139/80 - 89 mmHg与心血管风险降低无关，在年龄≥70岁时，将血压维持在130 - 139/80 - 89 mmHg可能更好。
