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收缩压和血糖处于目标范围内的时间与心血管疾病及全因死亡风险的关系。

Time in target range for systolic blood pressure and glucose with cardiovascular disease and all-cause mortality risks.

作者信息

Zhang Yijun, Tian Xue, Xu Qin, Xia Xue, Chen Shuohua, Wang Yi, Wu Shouling, Wang Anxin

机构信息

Department of Epidemiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China.

出版信息

Hypertens Res. 2025 Jan;48(1):256-272. doi: 10.1038/s41440-024-01969-0. Epub 2024 Oct 30.

Abstract

Evidence on the combined effect of time in the target range (TTR) for systolic blood pressure (SBP) and fasting blood glucose (FBG) in real-world settings was scarce. We aimed to evaluate the separate and combined effects of SBP TTR and FBG TTR on cardiovascular disease (CVD) and all-cause mortality risks among participants with comorbidity of hypertension and diabetes. The data was derived from the Kailuan study. The target ranges for SBP and FBG were set as 110-140 mmHg and 3.9-7.0 mmol/L, and linear interpolation to calculate TTR. Cox proportional hazard regression models were used to estimate the separate and combined effects of SBP TTR and FBG TTR on CVD and all-cause mortality risks. We included 11,899 participants with hypertension and diabetes comorbidity whose mean age was 54.52 ± 10.36 years, and 9,873 (83.00%) were male. After a follow-up of 6.67 years, 1,381 cases of CVD and 2,148 cases of all-cause mortality were documented. In the fully adjusted model, compared with the participants with both SBP TTR and FBG TTR lower than 25%, participants with both greater SBP TTR and FBG TTR had the lowest risks of CVD (HR: 0.53; 95%CI: 0.57-0.78) and mortality (HR: 0.59; 95%CI: 0.47-0.74). Per 1 SD increase in SBP TTR was associated with a 14% reduction in CVD risk (HR, 0.86; 95% CI, 0.80-0.92) and a 10% reduction in mortality risk (HR, 0.90; 95% CI, 0.85-0.95), all significant results were maintained in the FBG TTR analyses. Both higher SBP TTR and FBG TTR were associated with lower risks of CVD and all-cause mortality in participants with comorbidity of hypertension and diabetes. Simultaneous control of SBP and FBG within the target ranges is a beneficial strategy for CVD prevention.

摘要

在现实环境中,关于收缩压(SBP)和空腹血糖(FBG)处于目标范围内的时间(TTR)的联合效应的证据很少。我们旨在评估SBP TTR和FBG TTR对高血压和糖尿病合并症患者心血管疾病(CVD)和全因死亡风险的单独和联合效应。数据来自开滦研究。SBP和FBG的目标范围设定为110 - 140 mmHg和3.9 - 7.0 mmol/L,并采用线性插值法计算TTR。采用Cox比例风险回归模型来估计SBP TTR和FBG TTR对CVD和全因死亡风险的单独和联合效应。我们纳入了11899例高血压和糖尿病合并症患者,他们的平均年龄为54.52±10.36岁,其中9873例(83.00%)为男性。经过6.67年的随访,记录了1381例CVD病例和2148例全因死亡病例。在完全调整模型中,与SBP TTR和FBG TTR均低于25%的参与者相比,SBP TTR和FBG TTR均较高的参与者CVD风险最低(HR:0.53;95%CI:0.57 - 0.78),死亡风险最低(HR:0.59;95%CI:0.47 - 0.74)。SBP TTR每增加1个标准差,CVD风险降低14%(HR,0.86;95%CI,0.80 - 0.92),死亡风险降低10%(HR,0.90;95%CI,0.85 - 0.95),所有显著结果在FBG TTR分析中均得以维持。较高的SBP TTR和FBG TTR均与高血压和糖尿病合并症患者较低的CVD和全因死亡风险相关。在目标范围内同时控制SBP和FBG是预防CVD的有益策略。

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