The impact of history of hypertension and type 2 diabetes at baseline on the incidence of stroke and stroke mortality
The impact of history of hypertension and type 2 diabetes at baseline on the incidence of stroke and stroke mortality
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DOI：
10.1161/01.str.0000190894.30964.75
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发表时间：
2005-12-01
期刊：
影响因子：
8.3
通讯作者：
Tuomilehto, J
中科院分区：
文献类型：
--
作者：
Hu, G;Sarti, C;Tuomilehto, J
背景和目的-高血压和糖尿病都是卒中的强预测因子，但很少有研究评估它们对卒中风险的联合作用。我们前瞻性地评估了高血压和2型糖尿病的发病率和中风mortals.Methods -我们前瞻性地随访了49 582芬兰受试者的发病率和中风mortals. Methods的联合协会，年龄在25至74岁，没有中风和冠心病的历史在基线。中风风险的危险比（HR）估计的高血压和糖尿病status. Results-During平均随访19.1年，2978事件中风事件记录，其中924是致命的。年龄、性别和研究年份校正的卒中发生率HR为1.35（95% CI，1.21至1.51），1.98（95% CI，1.79 - 2.19），2.54（95% CI，1.61 - 4.01），3.51（95% CI，2.40 - 5.14）和4.50（95% CI，3.60 - 5.61），仅（血压140至159/90至94 mm Hg），伴高血压II（血压>= 160/ 95 mm Hg，或使用抗高血压药物），仅糖尿病，高血压I和糖尿病，同时患有II型高血压和糖尿病的受试者与不患有这两种疾病的受试者相比。脑卒中死亡率的相应HR分别为1.47、2.62、3.06、5.59和9.27。对体重指数、胆固醇、教育、吸烟、饮酒和体力活动的额外调整并没有明显改变这些风险估计。血压对糖尿病和非糖尿病受试者中风风险的影响相似。结论：高血压和2型糖尿病独立增加中风风险，两者联合可显著增加中风风险。被认为与高血压相关的卒中风险中有很大一部分可能归因于合并糖尿病。
Background and Purpose - Both hypertension and diabetes are strong predictors of stroke, but very few studies have assessed their joint effect on stroke risk. We evaluated prospectively the joint association of history of hypertension and type 2 diabetes on the incidence of stroke and stroke mortality.Methods - We prospectively followed 49 582 Finnish subjects aged 25 to 74 years without a history of stroke and coronary heart disease at baseline. Hazards ratios (HRs) for stroke risk were estimated by the hypertension and diabetes status.Results - During a mean follow-up of 19.1 years, 2978 incident stroke events were recorded, of which 924 were fatal. Age-, sex-, and study year-adjusted HRs of stroke incidence were 1.35 (95% CI, 1.21 to 1.51), 1.98 ( 95% CI, 1.79 to 2.19), 2.54 (95% CI, 1.61 to 4.01), 3.51 (95% CI, 2.40 to 5.14), and 4.50 (95% CI, 3.60 to 5.61), respectively, among subjects with hypertension I (blood pressure 140 to 159/90 to 94 mm Hg) only, with hypertension II (blood pressure >= 160/ 95 mm Hg, or using antihypertensive drugs) only, with diabetes only, with both hypertension I and diabetes, and with both hypertension II and diabetes compared with the subjects without either of the diseases. The corresponding HRs of stroke mortality were 1.47, 2.62, 3.06, 5.59, and 9.27, respectively. Additional adjustments for body mass index, cholesterol, education, smoking, alcohol consumption, and physical activity did not appreciably change these risk estimates. Blood pressure affected the risk of stroke similarly in diabetic and nondiabetic subjects.Conclusions - Hypertension and type 2 diabetes increase stroke risk independently, and their combination increases the risk drastically. A significant proportion of the risk of stroke assumed to be related to hypertension may be attributable to concomitant diabetes.