强化降压与高血压患者新发糖尿病风险：STEP 随机试验的事后分析。

Intensive blood pressure lowering and the risk of new-onset diabetes in patients with hypertension: a post-hoc analysis of the STEP randomized trial.

机构信息

Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beilishi Road 167, Xicheng District, Beijing 100037, China.

Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai 200080, China.

出版信息

Eur J Prev Cardiol. 2023 Aug 1;30(10):988-995. doi: 10.1093/eurjpc/zwad105.

DOI:10.1093/eurjpc/zwad105

PMID:37036035

Abstract

AIMS

The strategy of blood pressure intervention in the elderly hypertensive patients (STEP) trial reported the cardiovascular benefit of intensive systolic blood pressure (SBP) control in patients with hypertension. The association between intensive SBP lowering and the risk of new-onset diabetes is unclear. This study aimed to evaluate the effect of intensive SBP lowering on the incidence of new-onset diabetes.

METHODS AND RESULTS

Participants in STEP who had baseline fasting serum glucose (FSG) concentrations <7.0 mmol/L and no history of diabetes or hypoglycaemic medication use were included. The primary outcome was new-onset diabetes defined as the time to first occurrence of FSG concentrations ≥7.0 mmol/L. The secondary outcome was new-onset impaired fasting glucose (FSG: 5.6-6.9 mmol/L) in participants with normoglycemia. A competing risk proportional hazards regression model was used for analysis. The cohort comprised 5601 participants (mean age: 66.1 years) with a mean baseline SBP of 145.9 mmHg. Over a median follow-up of 3.42 years, 273 (9.6%) patients in the intensive SBP group (target, 110 to <130 mmHg) and 262 (9.5%) in the standard SBP group (target, 130 to <150 mmHg) developed diabetes (adjusted hazard ratio, 1.01; 95% confidence interval (CI), 0.86-1.20). The adjusted hazard ratio for the secondary outcome was 1.04 (95% CI, 0.91-1.18). The mean highest FSG concentration during the follow-up was 5.82 and 5.84 mmol/L in the intensive and standard groups, respectively.

CONCLUSION

Intensive SBP lowering is not associated with an altered risk of new-onset diabetes or impaired fasting glucose in hypertensive patients.

REGISTRATION

STEP ClinicalTrials.gov, number: NCT03015311.

摘要

目的

STEP 试验报道了老年高血压患者血压干预策略（STEP）中强化收缩压（SBP）控制可带来心血管获益。但强化 SBP 降低与新发糖尿病风险之间的关联尚不清楚。本研究旨在评估强化 SBP 降低对新发糖尿病的影响。

方法和结果

STEP 研究中纳入了基线空腹血糖（FSG）<7.0mmol/L、无糖尿病或低血糖药物使用史的患者。主要结局为新发糖尿病，定义为首次出现 FSG 浓度≥7.0mmol/L 的时间。次要结局为血糖正常者的新发空腹血糖受损（FSG：5.6-6.9mmol/L）。采用竞争风险比例风险回归模型进行分析。队列纳入 5601 例患者（平均年龄 66.1 岁），平均基线 SBP 为 145.9mmHg。中位随访 3.42 年后，强化 SBP 组（目标值为 110-<130mmHg）有 273 例（9.6%）患者和标准 SBP 组（目标值为 130-<150mmHg）有 262 例（9.5%）患者发生糖尿病（调整后的危险比，1.01；95%置信区间（CI），0.86-1.20）。次要结局的调整后危险比为 1.04（95%CI，0.91-1.18）。随访期间平均最高 FSG 浓度分别为强化组 5.82mmol/L 和标准组 5.84mmol/L。