Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine; Universidade Federal do Rio de Janeiro, Brazil.
Hypertension. 2023 Oct;80(10):2178-2186. doi: 10.1161/HYPERTENSIONAHA.123.21514. Epub 2023 Aug 7.
The prognostic value of on-treatment mean cumulative ambulatory blood pressures (BPs) in type 2 diabetes has never been investigated. We aimed to assess it in a prospective cohort of 647 individuals with type 2 diabetes.
Clinic-office and ambulatory BPs were measured at baseline and serially during follow-up. Multivariable Cox analyses assessed the associations between baseline and mean cumulative BPs with the occurrence of cardiovascular events, major adverse cardiovascular events, all-cause and cardiovascular mortality, and microvascular outcomes (microalbuminuria, renal failure, retinopathy, and peripheral neuropathy). C statistics and the integrated discrimination improvement (IDI) index evaluated the improvement in risk discrimination by using cumulative ambulatory BPs instead of baseline BPs.
Over a median follow-up of 10.6 years, there were 202 cardiovascular events (163 major adverse cardiovascular events), 254 all-cause deaths (118 cardiovascular); 125 individuals had microalbuminuria development/progression, 104 developed advanced renal failure, 159 had retinopathy, and 174 individuals had peripheral neuropathy development/progression. The risks associated with mean cumulative ambulatory BPs were in general higher than those associated with baseline BPs, particularly for cardiovascular (HR, 1.42 versus 1.25 for increments of 1 SD in 24-hour systolic blood pressure) and mortality outcomes (1.56 versus 1.26). Compared with cumulative clinic BPs, mean cumulative ambulatory BPs improved risk discrimination for most outcomes, with IDIs from 11% to 14% for major adverse cardiovascular events and mortality up to 24% to 26% for microalbuminuria and neuropathy.
Compared with clinic-office BPs, mean cumulative ambulatory BPs during follow-up improve risk discrimination for most complications and mortality in individuals with type 2 diabetes. Serial ambulatory BP monitoring shall be more widely used in clinical management.
治疗期间平均累积动态血压（BP）在 2 型糖尿病中的预后价值尚未被研究过。我们旨在 647 例 2 型糖尿病患者的前瞻性队列中评估它。
在基线和随访期间，测量诊室和动态血压。多变量 Cox 分析评估了基线和平均累积 BP 与心血管事件、主要不良心血管事件、全因和心血管死亡率以及微血管结局（微量白蛋白尿、肾衰竭、视网膜病变和周围神经病变）发生之间的关系。C 统计量和综合鉴别改善（IDI）指数评估了使用累积动态 BP 替代基线 BP 对风险鉴别能力的改善。
在中位数为 10.6 年的随访期间，有 202 例心血管事件（163 例主要不良心血管事件），254 例全因死亡（118 例心血管死亡）；125 例出现微量白蛋白尿进展/恶化，104 例出现晚期肾衰竭，159 例出现视网膜病变，174 例出现周围神经病变进展/恶化。平均累积动态 BP 相关的风险通常高于基线 BP 相关的风险，尤其是心血管（HR，24 小时收缩压每增加 1 SD，1.42 比 1.25）和死亡率（1.56 比 1.26）结局。与累积诊室 BP 相比，平均累积动态 BP 提高了大多数结局的风险鉴别能力，主要不良心血管事件和死亡率的 IDI 从 11%到 14%，微量白蛋白尿和神经病变的 IDI 高达 24%到 26%。
与诊室 BP 相比，随访期间平均累积动态 BP 改善了大多数 2 型糖尿病患者并发症和死亡率的风险鉴别能力。应更广泛地使用连续动态血压监测来进行临床管理。
