Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, Homburg/Saar 66421, Germany.
Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain.
Eur Heart J. 2024 Aug 16;45(31):2851-2861. doi: 10.1093/eurheartj/ehae337.
Guidelines suggest similar blood pressure (BP) targets in patients with and without diabetes and recommend ambulatory BP monitoring (ABPM) to diagnose and classify hypertension. It was explored whether different levels of ambulatory and office BP and different hypertension phenotypes associate with differences of risk in diabetes and no diabetes.
This analysis assessed outcome data from the Spanish ABPM Registry in 59 124 patients with complete available data. The associations between office, mean, daytime, and nighttime ambulatory BP with the risk in patients with or without diabetes were explored. The effects of diabetes on mortality in different hypertension phenotypes, i.e. sustained hypertension, white-coat hypertension, and masked hypertension, compared with normotension were studied. Analyses were done with Cox regression analyses and adjusted for demographic and clinical confounders.
A total of 59 124 patients were recruited from 223 primary care centres in Spain. The majority had an office systolic BP >140 mmHg (36 700 patients), and 23 128 (40.6%) patients were untreated. Diabetes was diagnosed in 11 391 patients (19.2%). Concomitant cardiovascular (CV) disease was present in 2521 patients (23.1%) with diabetes and 4616 (10.0%) without diabetes. Twenty-four-hour mean, daytime, and nighttime ambulatory BP were associated with increased risk in diabetes and no diabetes, while in office BP, there was no clear association with no differences with and without diabetes. While the relative association of BP to CV death risk was similar in diabetes compared with no diabetes (mean interaction P = .80, daytime interaction P = .97, and nighttime interaction P = .32), increased event rates occurred in diabetes for all ABPM parameters for CV death and all-cause death. White-coat hypertension was not associated with risk for CV death (hazard ratio 0.86; 95% confidence interval 0.72-1.03) and slightly reduced risk for all-cause death in no diabetes (hazard ratio 0.89; confidence interval 0.81-0.98) but without significant interaction between diabetes and no diabetes. Sustained hypertension and masked hypertension in diabetes and no diabetes were associated with even higher risk. There were no significant interactions in hypertensive phenotypes between diabetes and no diabetes and CV death risk (interaction P = .26), while some interaction was present for all-cause death (interaction P = .043) and non-CV death (interaction P = .053).
Diabetes increased the risk for all-cause death, CV, and non-CV death at every level of office and ambulatory BP. Masked and sustained hypertension confer to the highest risk, while white-coat hypertension appears grossly neutral without interaction of relative risk between diabetes and no diabetes. These results support recommendations of international guidelines for strict BP control and using ABPM for classification and assessment of risk and control of hypertension, particularly in patients with diabetes.
Not applicable.
指南建议糖尿病患者和非糖尿病患者的血压（BP）目标相似，并建议使用动态血压监测（ABPM）来诊断和分类高血压。本研究旨在探讨不同水平的动态和诊室 BP 以及不同的高血压表型与糖尿病和非糖尿病患者的风险差异是否相关。
本分析评估了来自西班牙 ABPM 登记处的 59124 例具有完整可用数据的患者的结局数据。探讨了诊室、平均、日间和夜间动态 BP 与糖尿病患者和非糖尿病患者风险之间的关系。研究了糖尿病在不同高血压表型（持续性高血压、白大衣高血压和隐蔽性高血压）与正常血压相比的死亡率中的影响。使用 Cox 回归分析进行分析，并调整了人口统计学和临床混杂因素。
共从西班牙 223 个基层医疗中心招募了 59124 例患者。大多数患者的诊室收缩压>140mmHg（36700 例），且 23128 例（40.6%）患者未接受治疗。11391 例（19.2%）患者被诊断为糖尿病。2521 例（23.1%）糖尿病患者和 4616 例（10.0%）非糖尿病患者存在合并心血管（CV）疾病。24 小时平均、日间和夜间动态 BP 与糖尿病和非糖尿病患者的风险增加相关，而诊室 BP 与糖尿病和非糖尿病患者的风险均无明显关联。虽然 BP 与 CV 死亡风险的相对相关性在糖尿病患者中与非糖尿病患者相似（平均交互 P=0.80，日间交互 P=0.97，夜间交互 P=0.32），但 CV 死亡和全因死亡的所有 ABPM 参数在糖尿病患者中的事件发生率更高。白大衣高血压与 CV 死亡风险无关（危险比 0.86；95%置信区间 0.72-1.03），且在非糖尿病患者中略微降低全因死亡风险（危险比 0.89；置信区间 0.81-0.98），但糖尿病和非糖尿病患者之间无显著交互作用。糖尿病和非糖尿病患者的持续性高血压和隐蔽性高血压与更高的风险相关。糖尿病和非糖尿病患者的 CV 死亡风险的高血压表型之间没有显著的交互作用（交互 P=0.26），而全因死亡（交互 P=0.043）和非 CV 死亡（交互 P=0.053）存在一些交互作用。
在每个诊室和动态 BP 水平，糖尿病均增加了全因死亡、CV 死亡和非 CV 死亡的风险。隐蔽性和持续性高血压带来的风险最高，而白大衣高血压似乎风险较低，且糖尿病和非糖尿病患者之间的相对风险无交互作用。这些结果支持国际指南关于严格控制 BP 和使用 ABPM 进行分类和评估风险以及控制高血压的建议，特别是在糖尿病患者中。
不适用。
