Blood pressure, glycemic control, and white matter hyperintensity progression in type 2 diabetics
Blood pressure, glycemic control, and white matter hyperintensity progression in type 2 diabetics
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DOI：
10.1212/wnl.0000000000007093
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发表时间：
2019-03-12
期刊：
影响因子：
9.9
通讯作者：
Rost, Natalia S.
中科院分区：
文献类型：
--
作者：
de Havenon, Adam;Majersik, Jennifer J.;Rost, Natalia S.
目的探讨2型糖尿病患者MRI上白色高信号（WMH）的进展是否与高血压均值（BPM）或血红蛋白Alc有关，以及高血压或血糖控制是否能降低WMH的进展。主要结局是基线和40个月MRI之间WMH体积的变化（Delta WMH），主要预测因子是MRI之间的BPM和Alc。额外的分析比较了Delta WMH在强化与标准血糖控制随机化武器（n = 502）和强化与标准血压控制随机化武器（n = 314）。收缩期BPM增加的三分位数（115 +/- 4、127 +/- 3和139 +/- 6 mm Hg）的Δ WMH分别为0.7、0.9和1.2 cm（3）（p < 0.001）。强化血压控制随机组与标准血压控制随机组的Delta WMH较低（Delta WMH = 0.67 +/- 0.95 vs 1.16 +/- 1.13 cm（3），p < 0.001），但血糖控制组无差异= 0.917）。强化血压控制干预减少了这种进展。糖尿病和高血压共病具有协同有害特性，增加微血管和大血管并发症的风险。这些结果为2型糖尿病患者积极控制血压提供了进一步的支持。
ObjectiveTo determine whether higher blood pressure mean (BPM) or hemoglobin Alc is associated with progression of white matter hyperintensity (WMH) on MRI in patients with type 2 diabetes, and whether intensive blood pressure or glycemic control can reduce that progression.MethodsWe performed a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD MIND) research materials. The primary outcome is change in WMH volume (Delta WMH) between a baseline and month-40 MRI, and the primary predictor is BPM and Alc between the MRIs. Additional analyses compared Delta WMH in the intensive vs standard glycemic control randomization arms (n = 502) and intensive vs standard blood pressure control randomization arms (n = 314).ResultsHigher systolic BPM, but not diastolic BPM or Alc, was associated with WMH progression. The Delta WMH in tertiles of increasing systolic BPM (115 +/- 4, 127 +/- 3, and 139 +/- 6 mm Hg) was 0.7, 0.9, and 1.2 cm(3) (p < 0.001). Delta WMH was lower in the intensive vs standard blood pressure control randomization arm (Delta WMH = 0.67 +/- 0.95 vs 1.16 +/- 1.13 cm(3), p < 0.001), but there was no difference in the glycemic control arms = 0.917).ConclusionIn ACCORD MIND, higher systolic blood pressure was associated with WMH progression. The intensive blood pressure control intervention reduced this progression. Comorbid diabetes and hypertension has synergistic deleterious properties that increase the risk of micro-and macrovascular complications. These results provide further support for an aggressive approach to blood pressure control in type 2 diabetics.