高血压与糖尿病联合作用对生存质量影响

  目的  了解农村非高血压人群空腹血糖（FPG）与血压的因果关系，为高血压及糖尿病危险因素的早期防控提供参考依据。  方法  于2013年1 — 8月在辽宁省大洼、彰武和辽阳县农村地区采用多阶段随机整群抽样方法建立了心血管疾病研究队列，并于2015年8月 — 2016年1月对其中4 145名≥35岁农村居民进行随访调查；采用双向因果关联模型描述FPG与血压的因果关系，并应用多元线性回归模型进一步验证。  结果  4 145名农村非高血压人群的平均随访时间为（28.79 ± 3.49）个月，基线和随访时的FPG分别为（5.51 ± 0.83）和（5.48 ± 1.07）mmol/L，收缩压（SBP）分别为（124.05 ± 9.62）和（125.12 ± 14.63） mm Hg，舒张压（DBP）分别为（75.17 ± 7.24）和（75.88 ± 9.33）mm Hg；在在双向因果关系模型中，基线FPG先于随访SBP（ρ₂ = 0.063，P < 0.001）和随访DBP（ρ₂ = 0.029，P = 0.031）；多元线性回归模型进一步验证了双向因果关联模型中的结果，基线FPG影响随访SBP（β = 1.535，P <0.001）和随访DBP（β = 0.393，P = 0.015）；SBP和DBP的变化值均值在FPG变化值的Q₁、Q₂、Q₃、Q₄分别为 – 0.79和 – 0.25 mm Hg、0.74和0.49 mm Hg、1.17和0.91 mm Hg、3.11 和1.68 mm Hg；FPG变化值的四分位数越高，SBP和DBP的变化值均值越大（均P < 0.001）。  结论  农村非高血压人群FPG和血压的因果关系是单向的，即FPG升高先于血压升高。

Comorbidities of diabetes and hyper-tension: mechanisms and approach to target organ protection

  Objective  To explore causal relationship between fasting plasma glucose (FPG) and blood pressure (BP) in rural normotensive population and to provide evidences for early prevention and control of hypertension and diabetes risk factors.  Methods  We established a cardiovascular disease study cohort consisting of 4 145 normotensive residents aged ≥ 35 years selected with stratified multistage random cluster sampling in three counties of Liaoning province from January to August 2013 and conducted a follow-up survey among the residents from August 2015 to January 2016. The causal relationship between BP and FPG was assessed with cross-lagged panel analysis and further verified with multivariate linear regression model.  Results  For all the participants, the mean follow-up time was 28.79 ± 3.49 months; the FPG at the baseline and follow-up survey were 5.51 ± 0.83 and 5.48 ± 1.07 mmol/L; the systolic blood pressure (SBP) were 124.05 ± 9.62 and 125.12 ± 14.63 mm Hg and the diastolic blood pressure (DBP) were 75.17 ± 7.24 and 75.88 ± 9.33 mm Hg at the baseline and follow-up survey, respectively. The cross-lagged panel analysis revealed that baseline FPG preceded the follow-up SBP (ρ₂ = 0.063, P < 0.001) and DBP (ρ₂ = 0.029, P = 0.031). The results of multivariate linear regression model further validated the findings resulted from the cross-lagged panel analysis that the baseline FPG affected follow-up SBP (β = 1.535, P < 0.001) and DBP (β = 0.393, P = 0.015). The mean values in the changes of SBP and DBP corresponding to the first to the fourth quartile of change values of FPG were – 0.79 and – 0.25 mm Hg, 0.74 and 0.49 mm Hg, 1.17 and 0.91 mm Hg, and 3.11 and 1.68 mm Hg, respectively; and the changes in the FPG value were positively correlated with the change of SBP and DBP (both P < 0.001).  Conclusion  The relationship between FPG and blood pressure is unidirectional causation in rural normotensive population and the increase in blood glucose level precedes the increase in blood pressure.