Wang Xiaopu, Pei Junyu, Zheng Keyang, Liu Maojun, Hu Xinqun
Libin Cardiovascular Institute of Alberta, University of Calgary, Health Sciences Centre, Calgary, Alberta, Canada.
Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha, China.
Diabetes Obes Metab. 2025 Mar;27(3):1208-1216. doi: 10.1111/dom.16112. Epub 2024 Dec 3.
The efficacy of intensive blood pressure (BP) control remains controversial, and the variability of HbA1c was a risk factor for macrovascular events in patients with type 2 diabetes. We investigated whether the HbA1c variability modifies the efficacy of intensive BP control.
Data from the Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD-BP) trial was utilized. K-means clustering was used to cluster patients into three groups based on the HbA1c variability score and baseline HbA1c values. Cox proportional hazard models and generalized linear models were used to measure the subgroup differences in intensive BP control treatment effects. The primary outcome was a composite of nonfatal myocardial infarction (MI), stroke, or death from cardiovascular causes.
In patients with low HbA1c variability rather than medium or high HbA1c variability, intensive BP control reduced the risk of the primary outcome on a relative scale (HR 0.60, 95%CI 0.40-0.90, p interaction was 0.03), non-fatal MI (HR 0.61, 95% CI 0.37-1.00, p interaction was 0.04) and stroke (HR 0.19, 95%CI 0.05-0.64, p interaction was 0.02) or absolute scale. Regardless of the variability group, intensive BP control did not reduce the risk of cardiovascular or all-cause mortality (p interaction >0.05) both on relative and absolute risk scales.
HbA1c variability had effect on the efficacy of intensive BP control and intensive BP control brought a significant macrovascular benefit in patients with type 2 diabetes and low HbA1c variability.
强化血压控制的疗效仍存在争议，糖化血红蛋白（HbA1c）变异性是2型糖尿病患者发生大血管事件的危险因素。我们研究了HbA1c变异性是否会改变强化血压控制的疗效。
利用糖尿病血压控制心血管风险行动（ACCORD-BP）试验的数据。基于HbA1c变异性评分和基线HbA1c值，采用K均值聚类法将患者分为三组。采用Cox比例风险模型和广义线性模型来衡量强化血压控制治疗效果的亚组差异。主要结局为非致死性心肌梗死（MI）、中风或心血管原因导致的死亡的复合结局。
在HbA1c变异性低而非中或高的患者中，强化血压控制在相对尺度上降低了主要结局的风险（风险比[HR]0.60，95%置信区间[CI]0.40-0.90，交互作用p值为0.03）、非致死性MI（HR 0.61，95%CI 0.37-1.00，交互作用p值为0.04）和中风（HR 0.19，95%CI 0.05-0.64，交互作用p值为0.02），或绝对尺度上降低了风险。无论变异性分组如何，强化血压控制在相对和绝对风险尺度上均未降低心血管或全因死亡率的风险（交互作用p值>0.05）。
HbA1c变异性对强化血压控制的疗效有影响，强化血压控制在HbA1c变异性低的2型糖尿病患者中带来了显著的大血管益处。
