Blood Pressure Variables and Cardiovascular Risk New Findings From ADVANCE
Blood Pressure Variables and Cardiovascular Risk New Findings From ADVANCE
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DOI：
10.1161/hypertensionaha.109.133041
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发表时间：
2009-08-01
期刊：
影响因子：
8.3
通讯作者：
Chalmers, John
中科院分区：
文献类型：
--
作者：
Kengne, Andre-Pascal;Czernichow, Sebastien;Chalmers, John
各种血压指标对2型糖尿病患者心血管风险的相对重要性尚未确定。本研究比较了不同基线血压变量（收缩压[SBP]、舒张压[DBP]、脉压[PP]和平均动脉压）与糖尿病和血管疾病作用中4.3年主要心血管事件风险之间的关联强度：Preterax和达美康-控释评价研究。11140名参与者的平均（SD）年龄为65.8岁（6.4岁）。在随访期间，记录了1000例主要心血管事件，559例主要冠状动脉事件和468例心血管死亡。校正年龄、性别和治疗分配后，SD增加1个时主要心血管事件风险的风险比（95%CI）为1.17收缩压（1.10至1.24）; PP为1.20（1.13至1.28）;平均动脉压为1.12（1.05至1.19）; DBP为1.04（0.98至1.11）。对于主要心血管和冠状动脉事件，SBP和PP的受试者工作特征曲线下面积略高于平均动脉压和DBP。使用实际血压值代替基线血压值略微改善了SBP、DBP和平均动脉压的效应估计值，SBP模型和PP模型之间的受试者工作特征曲线下面积无显著差异。总之，SBP和PP是参与糖尿病和血管疾病行动：Preterax和达美康-控释评价研究的相对老年2型糖尿病患者中主要心血管结局风险的2个最佳决定因素，DBP是最不有效的决定因素。然而，SBP可能是更广泛的年龄组和人群中最简单和最有用的预测因子。（高血压。2009; 54：399-404.）
The relative importance of various blood pressure indices on cardiovascular risk in people with type 2 diabetes mellitus has not been established. This study compares the strengths of the associations between different baseline blood pressure variables (systolic blood pressure [SBP], diastolic blood pressure [DBP], pulse pressure [PP], and mean arterial pressure) and the 4.3-year risk of major cardiovascular events in the Action in Diabetes and Vascular Disease: Preterax and Diamicron-Modified Release Controlled Evaluation Study. Mean (SD) age for the 11 140 participants was 65.8 years (6.4 years). During follow-up, 1000 major cardiovascular events, 559 major coronary events, and 468 cardiovascular deaths were recorded. After adjustment for age, sex, and treatment allocation, the hazard ratios (95% CIs) associated with 1 increment in SD for the risk of major cardiovascular events were 1.17 (1.10 to 1.24) for SBP; 1.20 (1.13 to 1.28) for PP; 1.12 (1.05 to 1.19) for mean arterial pressure; and 1.04 (0.98 to 1.11) for DBP. The areas under the receiver operating characteristic curve were slightly higher for SBP and PP compared with mean arterial pressure and DBP for major cardiovascular and coronary events. Using achieved instead of baseline blood pressure values marginally improved the effect estimates for SBP, DBP, and mean arterial pressure, with no significant differences in the areas under the receiver operating characteristic curve between models with SBP and those with PP. In conclusion, SBP and PP are the 2 best and DBP is the least effective determinant of the risk of major cardiovascular outcomes in the relatively old patients with type 2 diabetes mellitus participating in the Action in Diabetes and Vascular Disease: Preterax and Diamicron-Modified Release Controlled Evaluation Study. However, SBP may be the simplest and most useful predictor across a wider range of age groups and populations. (Hypertension. 2009; 54: 399-404.)