Department of Endocrinology, The First Affiliated Hospital of Hainan Medical University, Haikou, 570102 Hainan, China.
Jiangsu College of Nursing, Huaian, 223023 Jiangsu, China.
J Diabetes Res. 2022 Mar 22;2022:7876786. doi: 10.1155/2022/7876786. eCollection 2022.
To evaluate the effects of variations in systolic blood pressure (SBP) and pulse pressure (PP) on diabetic retinopathy (DR) in patients with type 2 diabetes.
A total of 3275 type 2 diabetes patients without DR at Taiwan Lee's United Clinic from 2002 to 2014 were enrolled in the study. The average age of the patients was 65.5 (±12.2) years, and the follow-up period ranged from 3 to 10 years. Blood pressure variability was defined as the standard deviation (SD) of the average blood pressure values over the entire study period and was calculated for each patient. The mean SD for SBP was 11.16, and a SBP ≥ 130 mmHg (1 mmHg = 0.133 kPa) was defined as high SBP. Based on these data, patients were divided into four groups as follows: group 1 (G1, mean SBP < 130 mmHg, SD of SBP < 11.16 mmHg), group 2 (G2, mean SBP < 130 mmHg, SD ≥ 11.16 mmHg), group 3 (G3, mean SBP ≥ 130 mmHg, SD of SBP < 11.16 mmHg), and group 4 (G4, mean SBP ≥ 130 mmHg, SD ≥ 11.16 mmHg). Based on a mean PP of 80 mmHg with a pulse pressure SD of 6.53 mmHg, the patients were regrouped into four groups designated G1'-G4'.
After adjusting for patient age, sex, and disease course, Cox regression showed that the mean and SD of SBP, pulse pressure, and their SDs were risk factors for DR. After stratifying the patients based on the mean and SD of the SBP, we found that the patients in the G4 group had the highest risk of DR (hazard ratio (HR) = 1.980, 95% CI: 1.7162.285, < 0.01) and patients in the G1 group had the lowest risk. Patients in the G3 group (HR = 1.409, 95% CI: 1.2841.546, < 0.01) had a higher risk of DR compared to those in the G2 group (HR = 1.353, 95% CI: 1.1161.640, < 0.01). After the restratification of patients based on the mean and SD of the pulse pressures, it was found that patients in the G2' group had the highest risk of DR (HR = 2.086, 95% CI: 1.6412.652, < 0.01), whilst patients in the G1' group had the lowest risk. Also, the risk of DR in the G4' group (HR = 1.507, 95% CI: 1.1352.000, < 0.01) was higher than that in the G3' group (HR = 1.289, 95% CI: 1.1811.408, < 0.01).
Variability in SBP and PP are risk factors for DR in patients with type 2 diabetes. The variability of PP was better able to predict the occurrence of DR than mean pulse pressure.
评估收缩压（SBP）和脉压（PP）变化对 2 型糖尿病患者糖尿病视网膜病变（DR）的影响。
共纳入 2002 年至 2014 年在台湾李联合诊所无 DR 的 3275 例 2 型糖尿病患者。患者平均年龄为 65.5（±12.2）岁，随访时间为 3 至 10 年。血压变异性定义为整个研究期间平均血压值的标准差（SD），并计算每位患者的血压变异性。SBP 的平均 SD 为 11.16mmHg，SBP≥130mmHg（1mmHg=0.133kPa）定义为高 SBP。基于这些数据，患者被分为四组：组 1（G1，平均 SBP＜130mmHg，SBP 的 SD＜11.16mmHg）、组 2（G2，平均 SBP＜130mmHg，SD≥11.16mmHg）、组 3（G3，平均 SBP≥130mmHg，SBP 的 SD＜11.16mmHg）和组 4（G4，平均 SBP≥130mmHg，SD≥11.16mmHg）。基于平均 PP 为 80mmHg 和脉压 SD 为 6.53mmHg，患者被重新分为四组，分别为 G1'-G4'。
调整患者年龄、性别和病程后，Cox 回归显示 SBP、PP 的平均值和 SD 及其 SD 是 DR 的危险因素。根据 SBP 的平均值和 SD 对患者进行分层后，我们发现 G4 组患者发生 DR 的风险最高（危险比（HR）=1.980，95%CI：1.7162.285，＜0.01），G1 组患者发生 DR 的风险最低。与 G2 组（HR=1.353，95%CI：1.1161.640，＜0.01）相比，G3 组（HR=1.409，95%CI：1.2841.546，＜0.01）患者发生 DR 的风险更高。根据脉压的平均值和 SD 对患者重新分层后，发现 G2'组患者发生 DR 的风险最高（HR=2.086，95%CI：1.6412.652，＜0.01），而 G1'组患者发生 DR 的风险最低。此外，G4'组（HR=1.507，95%CI：1.1352.000，＜0.01）患者发生 DR 的风险高于 G3'组（HR=1.289，95%CI：1.1811.408，＜0.01）。
SBP 和 PP 的变异性是 2 型糖尿病患者 DR 的危险因素。PP 的变异性比平均脉压更能预测 DR 的发生。
