Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study
Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study
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DOI：
10.1136/bmj.321.7258.412
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发表时间：
2000-08-12
影响因子：
105.7
通讯作者：
Holman, RR
中科院分区：
文献类型：
--
作者：
Adler, AI;Stratton, IM;Holman, RR
目的确定收缩压随时间变化与2型糖尿病患者大血管或微血管并发症风险之间的关系。设计前瞻性观察性研究。研究对象为英格兰、苏格兰和北方爱尔兰的23家医院诊所的4801名白色、亚洲印第安人和非洲加勒比人UKPDS患者，无论是否随机接受治疗，均纳入发病率分析;其中，3642例被纳入相对风险分析，结果测量主要预定义的综合临床结果：与糖尿病相关的任何并发症或死亡以及全因死亡率。次要汇总结局：心肌梗塞、中风、下肢截肢（包括外周血管疾病引起的死亡）和微血管疾病（主要是视网膜光凝）。单一终点：非致命性心力衰竭和白内障摘除术风险降低与更新的平均收缩压降低10 mm Hg相关，调整了特定的混杂因素结果除白内障摘除术外，临床并发症的发生率与收缩压显著相关。更新的平均收缩压每降低10 mm Hg，与糖尿病相关的任何并发症的风险降低12（95%，置信区间10%至14%，P < 0.0001），糖尿病相关死亡率为15%（12%~ 18%，P< 0.0001），心肌梗死为11%（7%~ 14%，P< 0.0001），微血管并发症为13%（10%~ 16%，P< 0.0001）。没有观察到任何终点的风险阈值。结论在2型糖尿病患者中，糖尿病并发症的风险与血压升高密切相关。血压的任何降低都可能降低并发症的风险，收缩压低于120 mm Hg的患者风险最低。
Objective To determine the relation between systolic blood pressure over time and the risk of macrovascular or microvascular complications in patients dth type 2 diabetes.Design Prospective observational study.Setting 23 hospital based clinics in England, Scotland and Northern Ireland Participants 4801 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk,Outcome measures Primary predefined aggregate clinical outcomes: any complications or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, lower extremity amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photocoagulation). Single end points: non-fatal heart failure and cataract extraction Risk reduction associated with a 10 mm Hg decrease in updated mean systolic blood pressure adjusted for specific confoundersResults The incidence of clinical complications was significantly associated with systolic blood pressure, except for cataract extraction. Each 10 mm Hg decrease in updated mean systolic blood pressure was associated with reductions in risk of 12% for any complication related to diabetes (95%, confidence interval 10% to 14%, P < 0.0001), 15% for deaths related to diabetes (12% to 18%, P< 0.0001), 11% for myocardial infarction (7% to 14%, P< 0.0001), and 13% for microvascular complications (10% to 16%, P< 0.0001). No threshold of risk was observed for any end point.Conclusions In patients with type 2 diabetes the risk of diabetic complications was strongly associated with raised blood pressure. Any reduction in blood pressure is likely to reduce the risk of complications, with the lowest risk being in those with systolic blood pressure less than 120 mm Hg.