Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, 21224, USA.
ESC Heart Fail. 2021 Aug;8(4):2959-2967. doi: 10.1002/ehf2.13385. Epub 2021 May 25.
Data on the association of long-term variability of blood pressure (BP) with incident heart failure (HF) in individuals with Type 2 diabetes are scarce. We evaluated this association in a large community-based sample of adults with Type 2 diabetes.
A total of 4200 participants with Type 2 diabetes who had available BP measurements at four visits (baseline and 12, 24, and 36 months) in the Look AHEAD (Action for Health in Diabetes) study were included. Variability of systolic BP (SBP) and diastolic BP (DBP) across the four visits was assessed using four metrics. Participants free of HF during the first 36 months were followed for HF events. Cox regression was used to generate hazard ratios (HRs) and 95% confidence intervals (CIs) for HF. Of the 4200 participants, the average age was 59 years [standard deviation (SD): 6.8]; 58.5% were women. Over a median follow-up of 6.7 years, 129 developed HF events. After adjusting for relevant confounders, the HR of incident HF for the highest vs. lowest quartile of SD of SBP was 1.77 (95% CI 1.01-3.09); the HR for the highest (vs. lowest) quartile of variability independent of the mean of SBP was 1.29 (95% CI 0.78-2.14). The adjusted HR for participants in the highest (compared with the lowest) quartile of SD of DBP was 1.61 (95% CI 1.01-2.59), and the adjusted HR for variability independent of the mean of DBP was 1.65 (95% CI 1.03-2.65).
A greater variability in SBP and DBP is independently associated with greater risk of incident HF in individuals with Type 2 diabetes.
关于 2 型糖尿病患者血压（BP）长期变异性与心力衰竭（HF）事件发生之间关联的数据较为匮乏。我们在一个大型的 2 型糖尿病患者社区样本中评估了这种关联。
共纳入 4200 名 2 型糖尿病患者，他们在 LOOK AHEAD（糖尿病行动研究）研究的 4 次就诊中（基线和 12、24、36 个月）有可获得的 BP 测量值。使用 4 项指标评估 4 次就诊时的收缩压（SBP）和舒张压（DBP）变异性。在最初的 36 个月内无 HF 事件的患者，对 HF 事件进行随访。Cox 回归用于生成 HF 的风险比（HR）和 95%置信区间（CI）。在 4200 名参与者中，平均年龄为 59 岁[标准差（SD）：6.8]；58.5%为女性。在中位随访 6.7 年期间，有 129 人发生 HF 事件。在调整了相关混杂因素后，SBP 标准差最高四分位与最低四分位相比，HF 发生率的 HR 为 1.77（95%CI 1.01-3.09）；SBP 均值之外的变异性最高四分位与最低四分位相比，HF 发生率的 HR 为 1.29（95%CI 0.78-2.14）。DBP 标准差最高四分位与最低四分位相比，参与者调整后的 HR 为 1.61（95%CI 1.01-2.59），DBP 均值之外的变异性最高四分位与最低四分位相比，参与者调整后的 HR 为 1.65（95%CI 1.03-2.65）。
SBP 和 DBP 的变异性越大，2 型糖尿病患者发生 HF 的风险就越高。
