Lin Chia-Hung, Wei Jung-Nan, Fan Kang-Chih, Fang Chi-Tai, Wu Wan-Chen, Yang Chung-Yi, Lin Mao-Shin, Shih Shyang-Rong, Hua Cyue-Huei, Hsein Yenh-Chen, Lin Jou-Wei, Chuang Lee-Ming, Li Hung-Yuan
Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
J Formos Med Assoc. 2022 Jan;121(1 Pt 1):193-201. doi: 10.1016/j.jfma.2021.02.022. Epub 2021 Mar 22.
BACKGROUND/PURPOSE: Hypertension is a risk factor of incident diabetes. In 2017, the ACC/AHA updated the definition of hypertension to above 130/80 mmHg, while the 2018 ESC/ESH guideline and the JNC7 criteria remained the cutoff of 140/90 mmHg. This study was aimed to investigate how different cutoffs of hypertension affect the association of hypertension to incident diabetes and the progression of insulin resistance.
A total of 1177 subjects without diabetes at baseline were followed for 4.5 years. Diabetes was diagnosed by the results of oral glucose tolerance tests and hemoglobin A1c, or if anti-diabetic agents were used.
Hypertension by both criteria was associated with incident diabetes. Change of HOMA2-IR every 5 years (ΔHOMA2-IR/5 yr) was higher in subjects with hypertension than those without (adjusted p = 0.044). Subjects with treated hypertension had the highest risk of diabetes (HR 2.98, p < 0.001) and ΔHOMA2-IR/5 yr, compared with subjects with normal blood pressure. However, the associations of hypertension, HR of incident diabetes and ΔHOMA2-IR/5 yr were attenuated by the 2017 ACC/AHA criteria, as compared with that by the JNC7 and 2018 ESC/ESH criteria.
Hypertension by both criteria is associated with incident diabetes and accelerated progression of insulin resistance, and the associations are attenuated by the 2017 ACC/AHA criteria.
背景/目的：高血压是新发糖尿病的一个危险因素。2017年，美国心脏病学会/美国心脏协会（ACC/AHA）将高血压的定义更新为高于130/80 mmHg，而2018年欧洲心脏病学会/欧洲高血压学会（ESC/ESH）指南和美国国家联合委员会第7版（JNC7）标准仍将临界值设定为140/90 mmHg。本研究旨在调查不同的高血压临界值如何影响高血压与新发糖尿病的关联以及胰岛素抵抗的进展。
共有1177名基线时无糖尿病的受试者被随访了4.5年。根据口服葡萄糖耐量试验结果、糖化血红蛋白A1c或是否使用抗糖尿病药物来诊断糖尿病。
两种标准定义的高血压均与新发糖尿病相关。高血压患者每5年的稳态模型评估的胰岛素抵抗指数变化值（ΔHOMA2-IR/5年）高于非高血压患者（校正p = 0.044）。与血压正常的受试者相比，接受治疗的高血压患者患糖尿病的风险最高（风险比2.98，p < 0.001），且ΔHOMA2-IR/5年最高。然而，与JNC7和2018年ESC/ESH标准相比，2017年ACC/AHA标准使高血压、新发糖尿病风险比及ΔHOMA2-IR/5年之间的关联减弱。
两种标准定义的高血压均与新发糖尿病及胰岛素抵抗的加速进展相关，且2017年ACC/AHA标准使这些关联减弱。
