血压控制与糖尿病发病关系的前瞻性研究

目的 探讨血压控制情况与新发糖尿病的关系.方法 采用前瞻性研究方法 ,以江苏省多代谢异常和代谢综合征综合防治研究队列满足条件的人群为研究对象,分析并比较基线血压正常组和基线高血压组随访血压控制在不同水平时糖尿病发病率;运用Cox比例风险模型分析血压控制情况与随访新发糖尿病的关系.结果 3146名研究对象中,有102例新发糖尿病患者.基线血压正常组(n=2369)和高血压组(n=777)糖尿病累积发病率分别为2.74%和4.76%;基线血压正常组与高血压组糖尿病发病率均随着SBP和DBP增加而上升;两组人群中,随访转为或仍然为高血压的人群糖尿病发病率均大于随访血压保持或控制为正常的人群(基线血压正常组5.6%vs.1.9%,基线高血压组7.1%vs.2.2%).调整基线年龄、性别和糖尿病一般危险因素后,基线血压正常组中随访转为高血压的人群相比血压保持正常的人群发生糖尿病的相对危险度(aRR值及95%CI)为1.84(1.00～3.63);基线高血压组中随访血压未得到控制相比血压得到控制的人群发生糖尿病的aRR值为1.90(1.03～3.74).若调整性别、年龄和基线代谢综合征,aRR值则分别为1.70(0.99～2.78)和1.90(1.04～3.75).结论 基线血压正常组与高血压患者,若有效控制其血压在正常水平均能降低糖尿病发病的风险.

A prospective study on the association between control of blood pressure and incidence of type 2 diabetes mellitus

Objective To investigate the relationship on the effect of blood pressure (BP) control and the incidence of new diabetes mellitus (DM) in a follow-up study. Methods In this prospective study,non-diabetic subjects (n=3146,41% men) were recruited from the program "Prevention of Multiple Metabolic disorders and metabolic syndrome (MS) in Jiangsu province" (PMMJS) to evaluate the risk of DM in relation to BP control program on both healthy or hypertensive patients. Results During the follow-up period,102 subjects developed diabetes. In both healthy or hypertensive patients gropes,the incidence rates of diabetes increased along with the increase of either systolic or diastolic BP and were significantly higher in subjects who had become hypertension (5.6%) or patients with uncontrolled (7.1%) BP at baseline survey than in those who had maintained normal BP (1.9%) or with controlled BP at baseline surbey (2.2%). After adjusted for age,sex and other diabetes-related risk factors at baseline study,the aRR of diabetes incidence for subjects with normal BP at baseline who became hypertension (1.84,95%CI: 1.00-3.63) was higher than who maintained normal BP (1.90,95% CI: 1.03-3.74) after the follow-up program,and hypertensive patients with uncontrolled BP was higher than those with controlled BP. When adjusted for baseline MS,the aRR (95% CI) for subjects with normal BP at baseline who had developed hypertension was 1.70 (0.99-2.78) compared those remained normal BP levels after the follow-up program,and 1.90 (1.04-3.75) for hypertensive patients with uncontrolled BP when compared with those whose BP had been under control. Conclusion When the BP level had been effectively under control,the risk of deveploping a type 2 diabetes could be reduced.