合并高血压的老年2型糖尿病患者血压控制目标探讨

目的探讨老年2型糖尿病合并高血压患者降压的目标值。方法选取2008年1月至2011年1月在福建省立医院内科就诊的707例65岁以上老年2型糖尿病合并高血压患者，其中男324例，女383例，平均年龄（72±6）岁。按收缩压（SBP）高低分为收缩压严格控制组（130mm Hg≤SBP〈140mmHg，1mmHg=0．133kPa）235例，收缩压宽松控制组（140mmHg≤SBP〈160mm Hg）472例，两组患者收缩压水平均维持至少3年。所有患者进行12导联心电图检查，预估肾小球滤过率（eGFR）通过Cockcroft—Gault公式计算。将心电图aVL导联R波的电压（RaVL）作为心血管风险的替代指标，将eGFR作为评价肾功能的指标。以RaVL≥0．57mV和〈0．57mV作为二分类变量，使用logistic回归法分析心血管疾病风险。结果收缩压宽松控制组与严格控制组RaVL分别为：0，55（0．50～0．59）、0．58（0．52～0．64）mV，差异无统计学意义（F：0．235，P〉0．05）。收缩压宽松控制组eGFR为55．6（53．2～58．0）ml／min，低于收缩压严格控制组59．6（56．2～63．1）ml／min]，但差异无统计学意义（F=1．289，P〉0．05）。将RaVL≥0．57mV及RaVL〈0．57mV作为因变量进行多因素logistic回归分析发现，收缩压宽松控制组RaVL≥0．57mV的风险与收缩压严格控制组相比差异无统计学意义（OR=0．927，95％CI：0．567～1．514，P〉0．05）。结论老年2型糖尿病合并高血压患者收缩压的目标值控制在140mm Hg以下可能并不改善心血管和肾脏预后。

Target of blood pressure control in elderly patients with type 2 diabetes and hypertension

Objective To explore the target of blood pressure control in elderly patients with type 2 diabetes and hypertension. Methods A total of 707 elderly patients （male/female： 324/383 ） with type 2 diabetes and hypertension between January 2008 and January 2011 were enrolled from Fujian Provincial Hospital. 235 patients were assigned into intensive systolic blood pressure （SBP） control group （130 - 139 mm Hg, 1 mm Hg = 0. 133 kPa） , while 472 patients were assigned into non-intensive SBP control group （ 140 - 159 mm Hg）. Both groups maintained their SBP level for at least 3 years. All of subjects underwent 12-lead electrocardiogram, and the vokage of R wave in lead aVL（RaVL） was used to estimate the risk of cardiovascular disease. Estimated glomerular filtration rate （eGFR） was estimated by Cockcroft-Gault formula for evaluation the renal function. Multivariate logistic regression analysis was used while RaVL ≥ 0. 57 mV and RaVL 〈 0. 57 mV as the dependent variable. Results The level of RaVL in intensive SBP control group and non-intensive SBP control group was 0. 55 （ 0. 50 - 0. 59 ） , 0. 58 （ 0. 52 - 0. 64 ） mV, respectively. The difference between the two groups was not statistically significant （ F = 0. 235, P 〉 0.05 ）. The value of eGFR in intensive SBP control group and non-intensive SBP control group was 59.6 （ 56. 2 - 63. 1 ） , 55.6（53. 2 -58. 0） ml/min, respectively. The difference was also not statistically significant（ F =1. 289 ,P 〉0. 05 ）. Multivariate logistic regression analysis showed that the risk of non-intensive SBP control group was not higher than intensive SBP control group （ OR = 0. 927,95% CI： 0. 567 - 1. 514, P 〉 0. 05 ）. Conclusion SBP below 140 mm Hg may not reduce cardiovascular and chronic renal disease risk in elderly patients with type 2 diabetes and hypertension.