住院2型糖尿病患者短期血压控制及影响因素探讨

目的:探讨住院2型糖尿病(T2DM)患者短期血压控制效果及影响因素.方法:169例伴发高血压的T2DM患者给予降压等综合治疗,以出院时血压130/80 mmHg(1 mmHg=0.133 kPa)为界限分为达标组(97例)及未达标组(72例),比较2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(MAP)水平的影响.结果:全组T2DM入院时收缩压(SBP)为(143±15)mmHg,舒张压(DBP)为(78±8)mmHg,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0.8种.未达标组患者入院时SBP(151±15)∶(137±12)mmHg,P<0.01]、DBP(80±9)∶(77±7)mmHg, P<0.01]均高于达标组,且TC及24 h尿白蛋白排泄率(UAE)显著升高.回归分析显示MAP与入院时SBP、DBP、TC及高血压病程显著正相关,与年龄呈负相关;MAP与UAE显著正相关(r=0.303, P<0.01).并发糖尿病肾病(DN)患者随UAE增多而SBP显著升高,大量蛋白尿者需要多种降压药物联合且血压难以控制.结论:T2DM患者门诊血压控制达标率低,住院短期治疗明显改善了血压控制水平;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UAE等因素影响;UAE增加可能是并发DN患者血压难以控制的直接原因.

Short-time intensified blood pressure control and its influencing factors in hospitalized patients with type 2 diabetes mellitus

Objective:To explore effects of short-time intensified blood pressure (BP) control and its influencing factors in hospitalized patients with type 2 diabetes mellitus (T2DM). Methods:The total of 169 T2DM patients with hypertension were hospitalized and synthetically treated according to local guidelines. They were allocated to targeted (n=97) and untargeted (n=72) group as the comparison between their out-hospital BP levels and the borderline BP level at 130/80 mmHg, 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)mmHg and (78±8)mmHg 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 0.8 increase of hypotensive agent amount. The untargeted group showed significantly higher in-hospital SBP (151±15]vs 137±12]mmHg, P<0.01) and DBP (80±9]vs 77±7]mmHg, P<0.01) 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 lead to poor BP control and short-time in-hospital treatments ameliorates the condition in T2DM patients. For hospitalized T2DM, BP control is 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.