Lin Beiru, Liu Xiaochuan, Yao Sichen, Pan Zhigang
Department of General Practice, Hainan West Central Hospital, Danzhou, Hainan, China.
Department of General Practice, Zhongshan Hospital, Fudan University, Shanghai, China.
Int J Hypertens. 2023 Mar 16;2023:7533353. doi: 10.1155/2023/7533353. eCollection 2023.
Previous studies indicated that intensive blood pressure (BP) control (systolic BP < 120 mm·Hg) compared with standard BP control (<140 mm·Hg) was associated with an increased risk of type 2 diabetes (T2D) and impaired fasting glucose (IFG) among hypertensive patients with normoglycemia. However, the impact of intensive BP control on the incidence of T2D for those with IFG is still unknown.
This was a secondary analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) of the study. We included participants with IFG at randomization, which was defined as fasting blood glucose (FBG) between 100 and 125 mg/dL. The primary outcome was incident T2D, defined as events of reaching FBG ≥ 126 mg/dL, participant self-report T2D at annual examination, or a record of hypoglycemic medications at follow-up. The secondary outcome was incident IFG reversion (IFGR), defined as the time to first FBG back to normoglycemia (<100 mg/dl) among participants without incident T2D. Cox proportional hazards models were used to compare the cumulative incidence of outcomes between the two BP control groups. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated.
A total of 3310 participants were included in our primary outcome analysis (median age 67 years, 29% female). There were 293 participants who developed T2D among the intensive BP control group and 256 participants who developed T2D among the standard BP control group, resulting in 56.87 (50.36-63.39) versus 49.33 (43.29-55.37) events per 1000 person-years of treatment (HR 1.18 [95% CI, 1.00-1.40], =0.052). After excluding 549 participants who developed T2D, 2761 participants were included in our secondary outcome analysis with 559 participants who developed IFGR among the intensive BP control group and 632 participants who developed IFGR among the standard BP control group, resulting in 141.20 (129.50-152.91) versus 158.20 (145.86,170.53) events per 1000 person-years of treatment (HR 0.9 [95% CI, 0.8-1.01], =0.067).
Our study found that in comparison to the standard BP control for hypertensive patients with IFG, intensive BP control was associated with a small increased risk of new-onset T2D, though it did not reach statistical significance. This kind of impact should be considered when implementing the strategy, especially for those with high risks of developing T2D. This trial is registered with NCT01206062.
先前的研究表明，与标准血压控制（收缩压<140 mmHg）相比，强化血压控制（收缩压<120 mmHg）与血糖正常的高血压患者发生2型糖尿病（T2D）和空腹血糖受损（IFG）的风险增加有关。然而，强化血压控制对IFG患者T2D发病率的影响仍不清楚。
这是对收缩压干预试验（SPRINT）研究的二次分析。我们纳入了随机分组时患有IFG的参与者，IFG定义为空腹血糖（FBG）在100至125 mg/dL之间。主要结局是新发T2D，定义为达到FBG≥126 mg/dL的事件、参与者在年度检查时自我报告的T2D或随访时的降糖药物记录。次要结局是IFG逆转（IFGR），定义为在无新发T2D的参与者中首次FBG恢复至血糖正常（<100 mg/dL）的时间。使用Cox比例风险模型比较两个血压控制组之间结局的累积发病率。计算风险比（HR）及其95%置信区间（CI）。
共有3310名参与者纳入我们的主要结局分析（中位年龄67岁，29%为女性）。强化血压控制组中有293名参与者发生T2D，标准血压控制组中有256名参与者发生T2D，导致每1000人年治疗的事件数为56.87（50.36 - 63.39）对49.33（43.29 - 55.37）（HR 1.18 [95% CI，1.00 - 1.40]，P = 0.052）。在排除549名发生T2D的参与者后，2761名参与者纳入我们的次要结局分析，强化血压控制组中有559名参与者发生IFGR，标准血压控制组中有632名参与者发生IFGR，导致每1000人年治疗的事件数为141.20（129.50 - 152.91）对158.20（145.86，170.53）（HR 0.9 [95% CI，0.8 - 1.01]，P = 0.067）。
我们的研究发现，与IFG高血压患者的标准血压控制相比，强化血压控制与新发T2D的风险小幅增加相关，尽管未达到统计学意义。在实施该策略时应考虑这种影响，尤其是对于发生T2D高风险的患者。本试验已在ClinicalTrials.gov注册，注册号为NCT01206062。
