住院2型糖尿病患者血压控制的影响因素

目的探讨住院2型糖尿病(type2diabetes mellitus,T2DM)患者血压控制的影响因素。方法 169例合并原发性高血压(高血压)的T2DM患者给予降压等综合治疗,以出院时血压130/80mm Hg(1mm Hg=0.133kPa)为界限分为达标组(n=97)及未达标组(n=72),比较两组入院时临床及实验室指标,并通过回归分析观察各种因素对出院时平均动脉压水平的影响。结果全组T2DM入院时收缩压为(143±15)mm Hg,舒张压为(78±8)mm Hg,控制达标率仅17.8%;出院时血压达标率57.4%,降压药物种类平均增加1种。未达标组患者入院时收缩压(151±15)mm Hg vs.(137±12)mm Hg,P0.05)、舒张压(80±9)mm Hg vs.(77±7)mm Hg,P0.05]均高于达标组,且血清总胆固醇浓度及24h尿白蛋白排泄率显著升高。回归分析显示,平均动脉压与入院时收缩压、舒张压、血清总胆固醇及高血压病程显著正相关,与年龄负相关;平均动脉压与尿白蛋白排泄率显著正相关(r=0.303,P0.01)。合并糖尿病肾病患者随尿白蛋白排泄率增多而收缩压显著升高,大量蛋白尿者需要多种降压药物联合治疗且血压难以控制。结论 T2DM患者门诊血压控制达标率低;住院T2DM患者血压控制受入院时血压水平、高血压病程、高胆固醇血症、高尿白蛋白排泄率等因素影响;尿白蛋白排泄率增加可能是合并糖尿病肾病患者血压难以控制的直接原因。

Influencing factors of blood pressure control in hospitalized patients with type 2 diabetes mellitus

Objectives To explore factors which affecting blood pressure（BP） control in hospitalized patients with type 2 diabetes mellitus （T2DM）.Methods One hundred and sixty nine T2DM patients with hypertension were hospitalized and synthetically treated according to localguidelines.They were allocated to targeted （n=97） and untargeted （n=72） groups as the comparison between their out-hospital BP levels and the borderline BP level at 130 / 80 mm Hg,the in- hospital clinical and laboratory data were then compared between 2 groups.Correlations between out-hospital mean arterial pressure （MAP） and various factors were elucidated by a multivariate regression.Results Systolic BP （SBP） and diastolic BP （DBP） were （143±15） mm Hg and （78±8） mm Hg respectively for 169 admitted patients.Only 17.8% of the patients got well-controlled BP by out-patient treatments,and hospitalized interventions increased this ratio to 57.4% accompanied with averagely 1 kind increasing of antihypotensive agent amount.The untargeted group showed significantly higher in-hospital SBP （151±15）mm Hg vs.（137±12）mm Hg,P〈0.05） and DBP （80±9） mm Hg vs.（77 ±7） mm Hg,P 0.05] than the targeted group,while plasma total cholesterol （TC） and daily urinary albumin excretion （UAE） were also significantly increased.Out-hospital MAP positively correlated with in-hospital SBP,DBP,TC,hypertension courses and negatively correlated with age,especially,UAE showed a strongly positive correlation with MAP （r=0.303,P〈0.01）.In patients with diabetic nephropathy （DN）,SBP remarkably elevated as UAE increased,more hypotensive agents were required and poor BP control was resulted in macroalbuminuric patients.Conclusions Out-patient treatments led to poor BP control in T2DM patients.For hospitalized T2DM,BP control was affected by several factors including in-hospital BP level,hypertension courses,plasma cholesterol level and increased UAE,DN itself may directly aggravate BP control in T2DM patients.