Association of systolic and diastolic blood pressure and all cause mortality in people with newly diagnosed type 2 diabetes: retrospective cohort study.
Association of systolic and diastolic blood pressure and all cause mortality in people with newly diagnosed type 2 diabetes: retrospective cohort study.
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DOI：
10.1136/bmj.e5567
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发表时间：
2012-08-30
期刊：
影响因子：
--
通讯作者：
Majeed A
中科院分区：
文献类型：
--
作者：
Vamos EP;Harris M;Millett C;Pape UJ;Khunti K;Curcin V;Molokhia M;Majeed A
目的探讨治疗第一年收缩压和舒张压对伴有或不伴有心血管疾病的新诊断2型糖尿病患者全因死亡率的影响。设计回顾性队列研究。设置英国全科医学研究数据库，1990年至2005年。参与者126 092名新诊断为2型糖尿病的成人患者（年龄≥18岁），已注册参加实践至少12个月。主要结局指标：全因死亡率。结果确诊前已有心血管疾病（心梗、脑卒中）的12379例（9.8%）。在中位3.5年的随访期间，我们记录了25495例（20.2%）死亡。在心血管疾病患者中，在调整基线特征（诊断时年龄、性别、实践水平聚类、剥夺评分、体重指数、吸烟、HbA1c和胆固醇水平以及血压）后，严格控制收缩压（<130毫米汞柱）和舒张压（<80毫米汞柱）与生存率的提高无关。低血压还与全因死亡风险增加有关。与病人通常控制收缩压(130 - 139毫米汞柱),所有导致死亡的危险比为2.79(95%可信区间1.74到4.48,P < 0.001),收缩压在110毫米汞柱。相比之下,病人通常控制舒张压(80 - 84毫米汞柱),风险比为1.32 (1.02 - 1.78,P = 0.04)和1.89 (1.40,2.56,P < 0.001),在70 - 74毫米汞柱,舒张期血压低于70毫米汞柱,分别。在没有心血管疾病的人群中也发现了类似的关联。对被诊断为高血压和接受高血压治疗的人的亚组分析证实了初步发现。结论血压低于130/80 mm Hg与新诊断糖尿病患者全因死亡风险降低无关，无论有无已知心血管疾病。低血压，特别是低于110/75毫米汞柱，与不良预后的风险增加有关。
Objective To examine the effect of systolic and diastolic blood pressure achieved in the first year of treatment on all cause mortality in patients newly diagnosed with type 2 diabetes, with and without established cardiovascular disease. Design Retrospective cohort study. Setting United Kingdom General Practice Research Database, between 1990 and 2005. Participants 126 092 adult patients (age ≥18 years) with a new diagnosis of type 2 diabetes who had been registered with participating practices for at least 12 months. Main outcome measure All cause mortality. Results Before diagnosis, 12 379 (9.8%) patients had established cardiovascular disease (myocardial infarction or stroke). During a median follow-up of 3.5 years, we recorded 25 495 (20.2%) deaths. In people with cardiovascular disease, tight control of systolic (<130 mm Hg) and diastolic (<80 mm Hg) blood pressure was not associated with improved survival, after adjustment for baseline characteristics (age at diagnosis, sex, practice level clustering, deprivation score, body mass index, smoking, HbA1c and cholesterol levels, and blood pressure). Low blood pressure was also associated with an increased risk of all cause mortality. Compared with patients who received usual control of systolic blood pressure (130-139 mm Hg), the hazard ratio of all cause mortality was 2.79 (95% confidence interval 1.74 to 4.48, P<0.001) for systolic blood pressure at 110 mm Hg. Compared with patients who received usual control of diastolic blood pressure (80-84 mm Hg), the hazard ratios were 1.32 (1.02 to 1.78, P=0.04) and 1.89 (1.40 to 2.56, P<0.001) for diastolic blood pressures at 70-74 mm Hg and lower than 70 mm Hg, respectively. Similar associations were found in people without cardiovascular disease. Subgroup analyses of people diagnosed with hypertension and who received treatment for hypertension confirmed initial findings. Conclusion Blood pressure below 130/80 mm Hg was not associated with reduced risk of all cause mortality in patients with newly diagnosed diabetes, with or without known cardiovascular disease. Low blood pressure, particularly below 110/75 mm Hg, was associated with an increased risk for poor outcomes.
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