The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
J Hum Hypertens. 2023 Mar;37(3):181-188. doi: 10.1038/s41371-022-00661-5. Epub 2022 Feb 19.
Clinical practice guidelines for patients with diabetes recommend using blood pressure (BP) and atherosclerotic cardiovascular disease (ASCVD) risk to guide antihypertensive treatment. While this approach directs treatment to patients who should receive a large ASCVD risk reduction, its effect on other outcomes is uncertain. The aim of this study was to assess the contributions of systolic blood pressure level (SBP) and predicted 10-year ASCVD risk using Pooled Cohort risk equations to the prediction of major macrovascular disease, death and major microvascular disease in patients with diabetes. Data came from 7426 individuals with type 2 diabetes (T2D) without macrovascular disease at baseline in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. The risk for major macrovascular events and death increased progressively across ASCVD risk categories. Compared to participants with 10-year predicted ASCVD risk <20% and SBP <130 mmHg, the hazard ratios (HRs) (95% confidence intervals (CIs)) associated with SBP ≥150 mmHg and 10-year predicted ASCVD risk <20%, 20-34% and ≥35% were 1.01 (0.58, 1.77), 1.90 (1.28, 2.84) and 2.82 (1.98, 4.01) for major macrovascular disease, respectively, and 0.83 (0.42, 1.62), 1.79 (1.13, 2.82) and 3.29 (2.22, 4.88) for death, respectively. The risk for major microvascular disease increased with BP regardless of ASCVD risk; HRs for SBP ≥150 mmHg and 10-year predicted ASCVD risk <20%, 20-34% and ≥35% vs. ASCVD risk <20% and SBP <130 mmHg were 1.52 (1.08,2.13), 1.47 (1.10, 1.96) and 1.23 (0.94, 1.60), respectively. ASCVD risk in addition to SBP improved the estimation of major macrovascular events and death but not major microvascular events among individuals with T2D.
临床实践指南建议糖尿病患者使用血压（BP）和动脉粥样硬化性心血管疾病（ASCVD）风险来指导降压治疗。虽然这种方法将治疗指向应该获得大量 ASCVD 风险降低的患者，但它对其他结果的影响尚不确定。本研究的目的是评估使用 Pooled Cohort 风险方程评估收缩压水平（SBP）和预测的 10 年 ASCVD 风险对糖尿病患者主要大血管疾病、死亡和主要微血管疾病的预测贡献。数据来自 ADVANCE 试验中基线时无大血管疾病的 7426 名 2 型糖尿病（T2D）个体。主要大血管事件和死亡的风险随着 ASCVD 风险类别而逐渐增加。与 10 年预测 ASCVD 风险<20%和 SBP<130mmHg 的参与者相比，SBP≥150mmHg 和 10 年预测 ASCVD 风险<20%、20-34%和≥35%相关的危险比（HR）（95%置信区间（CI））分别为 1.01（0.58，1.77）、1.90（1.28，2.84）和 2.82（1.98，4.01），主要大血管疾病，0.83（0.42，1.62），1.79（1.13，2.82）和 3.29（2.22，4.88）用于死亡。主要微血管疾病的风险随着 BP 的增加而增加，而与 ASCVD 风险无关；SBP≥150mmHg 和 10 年预测 ASCVD 风险<20%、20-34%和≥35%与 ASCVD 风险<20%和 SBP<130mmHg 的 HR 分别为 1.52（1.08，2.13）、1.47（1.10，1.96）和 1.23（0.94，1.60）。ASCVD 风险加上 SBP 改善了 T2D 个体主要大血管事件和死亡的估计，但对主要微血管事件没有改善。
