Is the Association of Diabetes With Uncontrolled Blood Pressure Stronger in Mexican Americans and Blacks Than in Whites Among Diagnosed Hypertensive Patients?
Is the Association of Diabetes With Uncontrolled Blood Pressure Stronger in Mexican Americans and Blacks Than in Whites Among Diagnosed Hypertensive Patients?
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DOI：
10.1093/ajh/hpt109
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发表时间：
2013-11-01
影响因子：
3.2
通讯作者：
Song, Ping
中科院分区：
文献类型：
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作者：
Liu, Xuefeng;Song, Ping
临床证据表明，糖尿病可引起高血压患者血压失控。然而，在确诊的高血压患者中，糖尿病与失控血压结局之间的相关性还没有得到种族差异的评估。从19992008全国健康和营养检查调查中收集了6,134名年龄在20岁的确诊高血压患者，采用分层多阶段设计。使用加权Logistic回归和线性回归模型得出未控制血压的优势比(OR)和相对OR，以及持续血压对种族/民族的影响差异。与没有糖尿病的参与者相比，患有糖尿病的非西班牙裔黑人参与者患未控制血压的几率高138%，墨西哥糖尿病参与者患未控制血压的几率高60%，患有糖尿病的非西班牙裔白人参与者患未控制血压的几率高161%。在墨西哥裔美国人中，糖尿病与失控血压的关联性低于非西班牙裔黑人和白人(墨西哥裔美国人与非西班牙裔黑人：相对OR 0.55，95%可信区间(CI)0.370.82；墨西哥裔美国人与非西班牙裔白人：相对OR 0.53，95%CI为0.350.80)；墨西哥裔美国人糖尿病与孤立失控收缩压的关联性低于非西班牙裔白人(墨西哥裔美国人与非西班牙裔白人：相对OR 0.62，95%CI 0.400.96)。与非西班牙裔白人相比，墨西哥裔美国人患糖尿病与收缩压和舒张压下降的关联性更强，与非西班牙裔黑人相比，糖尿病与舒张压下降的关联性更强。尽管墨西哥裔美国人的糖尿病患病率高于非西班牙裔白人，但糖尿病与失控血压结局的相关性较低。考虑到白人占美国高血压人口的大多数，糖尿病与白人血压结果之间的更强关联应该引起临床关注。
Clinical evidence shows that diabetes may provoke uncontrolled blood pressure (BP) in hypertensive patients. However, racial differences in the associations of diabetes with uncontrolled BP outcomes among diagnosed hypertensive patients have not been evaluated.A total of 6,134 diagnosed hypertensive subjects aged 20 years were collected from the National Health and Nutrition Examination Survey 19992008 with a stratified multistage design. Odds ratios (ORs) and relative ORs of uncontrolled BP and effect differences in continuous BP for diabetes over race/ethnicity were derived using weighted logistic regression and linear regression models.Compared with participants who did not have diabetes, non-Hispanic black participants with diabetes had a 138% higher chance of having uncontrolled BP, Mexican participants with diabetes had a 60% higher chance of having uncontrolled BP, and non-Hispanic white participants with diabetes had a 161% higher chances of having uncontrolled BP. The association of diabetes with uncontrolled BP was lower in Mexican Americans than in non-Hispanic blacks and whites (Mexican Americans vs. non-Hispanic blacks: relative OR 0.55, 95% confidence interval (CI) 0.370.82; Mexican Americans vs. non-Hispanic whites: relative OR 0.53, 95% CI 0.350.80) and the association of diabetes with isolated uncontrolled systolic BP was lower in Mexican Americans than in non-Hispanic whites (Mexican Americans vs. non-Hispanic whites: relative OR 0.62, 95% CI 0.400.96). Mexican Americans have a stronger associaton of diabetes with decreased systolic BP and diastolic BP than non-Hispanic whites, and a stronger association of diabetes with decreased diastolic BP than non-Hispanic blacks.The association of diabetes with uncontrolled BP outcomes is lower despite higher prevalence of diabetes in Mexican Americans than in non-Hispanic whites. The stronger association of diabetes with BP outcomes in whites should be of clinical concern, considering they account for the majority of the hypertensive population in the United States.