Adverse prognostic significance of new diabetes in treated hypertensive subjects
Adverse prognostic significance of new diabetes in treated hypertensive subjects
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DOI：
10.1161/01.hyp.0000125726.92964.ab
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发表时间：
2004-05-01
期刊：
影响因子：
8.3
通讯作者：
Porcellati, C
中科院分区：
文献类型：
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作者：
Verdecchia, P;Reboldi, G;Porcellati, C
非糖尿病高血压患者在治疗期间可能发生糖尿病，但这种现象的长期心血管影响尚不清楚。我们确定了高血压患者新发糖尿病的预后价值。在一项长期队列研究中，795名最初未经治疗的高血压受试者（其中6.5%患有2型糖尿病）接受了诊断程序，包括24小时动态血压（BP）监测和心电图（ECG）。在没有心血管事件的情况下，在中位数3.1年后重复手术。随访时间为1至16年（中位数6.0）。在最初无糖尿病的受试者中，5.8%发生了新发糖尿病。53.5%的受试者接受抗高血压治疗，包括利尿剂，而未发生糖尿病的受试者为30.4%（P=0.002）。入组时的血糖（P=0.0001）和随访时的利尿剂治疗（P=0.004）是新发糖尿病的独立预测因素。随访访视后，63例受试者发生了首次心血管事件。两次访视时非糖尿病受试者、新发糖尿病受试者和入组时糖尿病受试者的事件发生率分别为0.97、3.90和4.70x100人-年（P=0.0001）。校正包括24小时动态血压在内的混杂因素后，与持续无糖尿病组相比，新发糖尿病组和既往糖尿病组的事件相对风险分别为2.92（95%CI：1.33 - 6.41; P=0.007）和3.57（95%CI：1.65 - 7.73; P=0.001）。在接受治疗的高血压受试者中，新发糖尿病的发生预示着后续心血管疾病的风险，与既往已知的糖尿病风险并无不同。
Diabetes may develop in nondiabetic hypertensive subjects during treatment, but the long-term cardiovascular implications of this phenomenon are not clear. We determined the prognostic value of new diabetes in hypertensive subjects. In a long-term cohort study, 795 initially untreated hypertensive subjects, 6.5% of whom with type 2 diabetes, underwent diagnostic procedures including 24-hour ambulatory blood pressure (BP) monitoring and electrocardiography (ECG). Procedures were repeated after a median of 3.1 years in the absence of cardiovascular events. Follow-up duration was 1 to 16 years (median 6.0). New diabetes occurred in 5.8% of subjects initially without diabetes. Antihypertensive treatment included a diuretic in 53.5% of these subjects, versus 30.4% of those in whom diabetes did not develop (P=0.002). Plasma glucose at entry (P=0.0001) and diuretic treatment on follow-up (P=0.004) were independent predictors of new diabetes. Subsequent to the follow-up visit, a first cardiovascular event occurred in 63 subjects. Event rate in nondiabetic subjects at both visits, new diabetes, and diabetes at entry were 0.97, 3.90, and 4.70x100 person-years, respectively (P=0.0001). After adjustment for several confounders, including 24-hour ambulatory BP, the relative risk of events was 2.92 (95% CI: 1.33 to 6.41; P=0.007) in the group with new diabetes and 3.57 (95% CI: 1.65 to 7.73; P=0.001) in the group with previous diabetes, when compared with the group persistently free of diabetes. In treated hypertensive subjects, occurrence of new diabetes portends a risk for subsequent cardiovascular disease that is not dissimilar from that of previously known diabetes.