Chen KangYu, Wu Zhenqiang, Shi Rui, Wang Qi, Yuan Xiaodan, Wu Guohong, Shi Guoshuai, Li Chao, Chen Tao
Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China.
Department of Geriatric Medicine, The University of Auckland, Auckland, PO Box 93 503, New Zealand.
Diabetes Res Clin Pract. 2023 Apr;198:110600. doi: 10.1016/j.diabres.2023.110600. Epub 2023 Feb 27.
To examine the prognostic value of time in target range (TIR) with adverse outcomes and validate it with common blood pressure (BP) metrics among patients with Type 2 diabetes mellitus.
We performed a post hoc analysis of the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial. TIR for each subject was calculated using linear interpolation and an SBP target range of 110 to 130 mmHg. Cox models were used to assess the association of TIR and other BP metrics with the rate of clinical outcomes.
A higher TIR (61.9-100.0 %) was associated with a 46 % reduction in major adverse cardiovascular events (MACE) (hazard ratio [HR]:0.54; 95 % CI: 0.43, 0.67) compared with TIR 0-22.9 %. Results were similar for stroke (0.19; 0.10, 0.36), myocardial infarction (0.67; 0.51, 0.89), heart failure (0.47; 0.33, 0.66), cardiovascular death (0.63; 0.42, 0.93) and all-cause mortality (0.70; 0.54, 0.91). Further analyses suggested a curvilinear association of TIR with MACE, and this association was independent with baseline, final SBP, mean SBP, or visit-to-visit SBP variability.
Longer TIR is associated with lower cardiovascular risk and may add value as an outcome measure for hypertension control studies among patients with diabetes.
研究2型糖尿病患者中目标范围内时间（TIR）对不良结局的预后价值，并使用常见血压（BP）指标对其进行验证。
我们对ACCORD（控制糖尿病心血管风险行动）试验进行了事后分析。使用线性插值法计算每个受试者的TIR，收缩压目标范围为110至130mmHg。采用Cox模型评估TIR和其他血压指标与临床结局发生率之间的关联。
与TIR为0-22.9%相比，较高的TIR（61.9-100.0%）与主要不良心血管事件（MACE）减少46%相关（风险比[HR]：0.54；95%置信区间：0.43，0.67）。中风（0.19；0.10，0.36）、心肌梗死（0.67；0.51，0.89）、心力衰竭（0.47；0.33，0.66）、心血管死亡（0.63；0.42，0.93）和全因死亡率（0.70；0.54，0.91）的结果相似。进一步分析表明TIR与MACE呈曲线关联，且这种关联独立于基线、最终收缩压、平均收缩压或每次就诊收缩压变异性。
较长的TIR与较低的心血管风险相关，可能作为糖尿病患者高血压控制研究的结局指标增加价值。
