Samuelsson O, Hedner T, Persson B, Andersson O, Berglund G, Wilhelmesen L
Section of Preventive Medicine, University of Göteborg, Sweden.
J Intern Med. 1994 Mar;235(3):217-27. doi: 10.1111/j.1365-2796.1994.tb01063.x.
To analyse the importance of diabetes mellitus and hypertriglyceridaemia as potential risk factors for coronary heart disease (CHD) in middle-aged, treated hypertensive men.
A prospective, long-term observational study.
Derived from a random population sample--686 hypertensive men aged 47-54 years at entry--followed for 15 years at a special out-patient hypertension clinic.
The patients were mainly treated with beta-adrenoceptor blockers and/or thiazide diuretics. Cardiovascular morbidity was closely monitored during follow-up.
In all, 133 subjects suffered a CHD event during follow-up. The presence of diabetes mellitus at entry more than doubled the CHD risk and a 1 mmol l-1 increment of the serum triglyceride level at entry increased the CHD risk by 21%. In multivariate analyses, smoking, the presence of diabetes mellitus at entry, serum cholesterol and signs or symptoms of hypertensive end organ damage were found to be independent risk factors for CHD. In absolute terms the existence of cardiovascular damage was of much greater prognostic importance than were the presence of various metabolic abnormalities. Of the mean in-study variables, both the average serum cholesterol level and the achieved diastolic blood pressure were significantly associated with CHD. However, new diabetes mellitus which developed during follow-up as well as mean serum triglyceride levels were not associated with CHD.
Diabetes mellitus and hypertriglyceridaemia present at the start of treatment have a prognostic impact in treated hypertensive men, whereas when such metabolic disorders develop during drug treatment they seem to be of much less importance. Smoking and already existing evidence of hypertensive end organ damage are of utmost importance for the prognosis in this type of patient.
分析糖尿病和高甘油三酯血症作为中年接受治疗的高血压男性冠心病（CHD）潜在危险因素的重要性。
一项前瞻性长期观察性研究。
来自随机人群样本——686名年龄在47 - 54岁的高血压男性，入组时在一家特殊的高血压门诊接受了15年的随访。
患者主要接受β - 肾上腺素能受体阻滞剂和/或噻嗪类利尿剂治疗。随访期间密切监测心血管疾病发病率。
共有133名受试者在随访期间发生冠心病事件。入组时患有糖尿病使冠心病风险增加一倍多，入组时血清甘油三酯水平每升高1 mmol/L，冠心病风险增加21%。多因素分析显示，吸烟、入组时患有糖尿病、血清胆固醇以及高血压靶器官损害的体征或症状是冠心病的独立危险因素。从绝对意义上讲，心血管损害的存在比各种代谢异常的存在对预后的影响更大。在研究期间的平均变量中，平均血清胆固醇水平和达到的舒张压均与冠心病显著相关。然而，随访期间新发糖尿病以及平均血清甘油三酯水平与冠心病无关。
治疗开始时存在的糖尿病和高甘油三酯血症对接受治疗的高血压男性的预后有影响，而在药物治疗期间出现的此类代谢紊乱似乎重要性要小得多。吸烟和已存在的高血压靶器官损害证据对这类患者的预后至关重要。
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