Determinants of new-onset diabetes among 19,257 hypertensive patients randomized in the Anglo-Scandinavian Cardiac Outcomes Trial-blood pressure lowering arm and the relative influence of antihypertensive medication
Determinants of new-onset diabetes among 19,257 hypertensive patients randomized in the Anglo-Scandinavian Cardiac Outcomes Trial-blood pressure lowering arm and the relative influence of antihypertensive medication
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DOI：
10.2337/dc07-1768
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发表时间：
2008-05-01
期刊：
影响因子：
16.2
通讯作者：
Poulter, N. R.
中科院分区：
文献类型：
--
作者：
Gupta, Ajay K.;Dahlof, Bjorn;Poulter, N. R.
目的：本研究的目的是确定高血压患者新发糖尿病（NOD）的基线预测因素，并制定风险评分来识别NOD的高危人群。研究设计和方法：在盎格鲁-斯堪的纳维亚心脏结局试验-降压组（asscott - bpla）的19257名高血压患者中，随机分配接受两种降压方案（阿替洛尔+/-噻嗪或氨氯地平+/-培哚普利）中的一种，14120名患者处于危险中。患糖尿病的风险其中，1366例（9.7%）在中位随访5.5年期间发展为NOD。建立多变量Cox模型以确定NOD和个体风险评分的独立预测因子。结果：NOD与基线空腹血糖（FPG）、BMI、血清甘油三酯和收缩压升高显著相关。相比之下，氨氯地平+/-培哚普利治疗与阿替洛尔+/-噻嗪治疗相比（风险比0.66 [95% CI 0.59-0.74]）、高高密度脂蛋白胆固醇、饮酒和年龄bb0 ~ 55岁是显著的保护因素。FPG是最有效的预测因子，每升高0.5 mmol/l，风险增加5.8倍（95% Cl 5.23-6.43）。随着风险评分的增加，NOD的风险稳步增加，与最低四分位数的患者相比，最高四分位数的患者NOD的风险增加了19倍（95% CI 14.3-25.4）。该模型具有良好的内部效度和判别能力。结论：基线FPG >5 mmol/l、BMI和阿替洛尔+/-利尿剂方案的使用是高血压患者NOD的主要决定因素。根据这些数据建立的模型可以准确预测高血压患者的NOD。
OBJECTIVE - The purpose of this study was to determine the baseline predictors of new-onset diabetes (NOD) in hypertensive patients and to develop a risk score to identify those at high risk of NOD.RESEARCH DESIGN AND METHODS - Among 19,257 hypertensive patients in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) who were randomly assigned to receive one of two antihypertensive regimens (atenolol +/- thiazide or amlodipine +/- perindopril), 14,120 were at risk. of developing diabetes at baseline. Of these, '1,366 (9.7%) subsequently developed NOD during median follow-up of 5.5 years. A multivariate Cox model was developed to identify the independent predictors of NOD and individual risk scores.RESULTS - NOD was significantly associated with an increase in baseline fasting plasma glucose (FPG), BMI, serum triglycerides, and systolic blood pressure. In contrast, amlodipine +/- perindopril in comparison Aith atenolol +/- thiazide treatment (hazard ratio 0.66 [95% CI 0.59-0.74]), high HDL cholesterol, alcohol use, and age >55 years were found to be significantly protective factors. FPG was the most powerful predictor with risk increasing by 5.8 times (95% Cl 5.23-6.43) for each millimole per liter rise >5 mmol/l. The risk of NOD increased steadily with increasing quartile of risk score, with a 19-fold increase (95% CI 14.3-25.4) among those in the highest compared with those in the lowest quartile. The model showed excellent internal validity and discriminative ability.CONCLUSIONS - Baseline FPG >5 mmol/l, BMI, and use of an atenolol +/- diuretic regimen were among the major determinants of NOD in hypertensive patients. The model developed from these data allows accurate prediction of NOD among hypertensive subjects.