Ambulatory blood pressure is a better marker than clinic blood pressure in predicting cardiovascular events in patients with/without type 2 diabetes
Ambulatory blood pressure is a better marker than clinic blood pressure in predicting cardiovascular events in patients with/without type 2 diabetes
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DOI：
10.1038/ajh.2008.4
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发表时间：
2008-04-01
影响因子：
3.2
通讯作者：
Kario, Kazuomi
中科院分区：
文献类型：
--
作者：
Eguchi, Kazuo;Pickering, Thomas G.;Kario, Kazuomi
背景动态血压（ABP）对2型糖尿病（T2 DM）患者的预后意义尚未确定。方法为了阐明ABP对T2 DM患者或非T2 DM患者心血管预后的影响，我们对来自日本9个研究中心的1，268名受试者进行了ABP监测（ABPM），这些受试者正在接受高血压评估。患者的平均年龄为70.4 ± 9.9岁，其中301人患有糖尿病。随访50 ~ 23个月。我们研究了心血管疾病（CVD）的发病率与不同ABP指标之间的关系，包括清醒收缩压（SBP <135、135 -150和> 150 mmHg）、睡眠收缩压（SBP <120、120 -135和> 135 mmHg）和夜间血压（BP）的下降趋势（勺型、非勺型和杓型）。考克斯回归模型，以控制经典的危险因素。结果较高的清醒和睡眠SBP预测较高的心血管疾病的发病率在糖尿病患者和非糖尿病患者。在多变量分析中，两组患者清醒和睡眠时SBP升高预测CVD风险增加比1313诊所更准确。两组ABP水平与CVD的关系相似。Kaplan-Meier分析显示，非勺型和勺型患者的CVD发生率相似，但勺型患者发生CVD的危险性最高（P < 0.01）。Riser模式与CVD风险增加150%相似，in both groups.CONCLUSIONS这些研究结果表明，ABPM是一个更好的预测心血管风险比诊所BP，这适用于患者或不T2 DM。
BACKGROUND The prognostic significance of ambulatory blood pressure (ABP) has not been established in patients with type 2 diabetes (T2DM). METHODS In order to clarify the impact of ABP on cardiovascular prognosis in patients with or without T2DM, we performed ABP monitoring (ABPM) in 1,268 subjects recruited from nine sites in Japan, who were being evaluated for hypertension. The mean age of the patients was 70.4 +/- 9.9 years, and 301 of them had diabetes. The patients were followed up for 50 23 months. We investigated the relation between incidence of cardiovascular diseases (CVDs) and different measures of ABP, including three categories of awake systolic blood pressure (SBP < 135,135-150, and > 150 mm Hg), sleep SBP (< 120,120-135, and > 135 mm Hg), and dipping trends in nocturnal blood pressure (BP) (dippers, nondippers, and risers). Cox regression models were used in order to control for classic risk factors.RESULTS Higher awake and sleep SBPs predicted higher incidence of CVD in patients with and without diabetes. In multivariable analyses, elevated SBPs while awake and asleep predicted increased risk of CVD more accurately than clinic 1313 did, in both groups of patients. The relationships between ABP level and CVD were similar in both groups. In Kaplan-Meier analyses, the incidence of CVD in nondippers was similar to that in dippers, but risers experienced the highest risk of CVD in both groups (P < 0.01). The riser pattern was associated with a similar to 150% increase in risk of CVD, in both groups.CONCLUSIONS These findings suggest that ABPM is a better predictor of cardiovascular risk than clinic BP, and that this holds true for patients with or without T2DM.