Diabetes Care：糖尿病患者早期控制血压可降低心血管事件发生

为了评估早期进行血压控制对伴新发高血压的糖尿病患者主要心血管事件的影响，来自美国明尼阿波里斯市卫生伙伴研究基金会的Patrick J Oconnor博士及其团队进行了一项研究，该研究结果发表在2013年2月的美国《糖尿病治疗》（Diabetes Care）杂志上。该研究发现对新发高血压的糖尿病患者积极行血压控制可带来显著的短期临床获益。
该研究中，受试者包括15,665例新近诊断高血压的糖尿病患者，基线时均无冠心病或脑血管疾病。应用泊松回归模型评价高血压起病1年内合理控制血压能否预测糖尿病患者的主要心血管事件的发生风险。在行模型分析时对基线Framingham风险评分（FRS）和其它协变量分别做校正或非校正处理。
该研究结果表明，受试者平均年龄51.5岁，高血压起病时的平均血压为136.8/80.8mmHg。高血压起病第一年后，平均血压降至131.4/78.0mmHg，其中32.9%受试者血压<130/80 mmHg，80.2%受试者血压<140/90 mmHg，平均随访时间为3.2年。经年龄校正后，1年平均血压<130/80、130-139/80-89、≥140/90 mmHg受试者的主要心血管事件发生率分别为5.10、4.27和6.94个事件数/1000人年（P=0.004）。在FRS校正模型中，起病第一年平均血压≥140/90 mmHg的受试者主要心血管事件发生率显著升高（风险比为1.30 [95% CI 1.01-1.169]；P = 0.04）。
该研究发现，高血压发病第一年血压控制不佳可显著增加三年内发生主要心血管事件的可能性。对新发高血压的糖尿病患者积极行血压控制可带来显著的短期临床获益。
与糖尿病相关的拓展阅读：

• Stroke：糖尿病患者缺血性卒中风险或无种族差异
• Clin Gastroenterol H：巴雷特食管与2型糖尿病相关
• Diabetes Care：良好的血糖和血压控制有益于延长糖尿病患者生存期
• Diabetic Med：高血压患者治疗时HDL低预示新发糖尿病风险更高
• AACE2013：糖尿病治疗方案
• NEJM：美国糖尿病防治十年进展回顾
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Benefits of early hypertension control on cardiovascular outcomes in patients with diabetes.
OBJECTIVE
To assess the impact of early hypertension (HT) control on occurrence of subsequent major cardiovascular events in those with diabetes and recent-onset HT.
RESEARCH DESIGN AND METHODS
Study subjects were 15,665 adults with diabetes but no diagnosed coronary or cerebrovascular disease at baseline who met standard criteria for new-onset HT. Poisson regression models assessed whether adequate blood pressure control within 1 year of HT onset predicts subsequent occurrence of major cardiovascular events with and without adjustment for baseline Framingham Risk Score (FRS) and other covariates.
RESULTS
Mean age was 51.5 years, and mean blood pressure at HT onset was 136.8/80.8 mmHg. In the year after HT onset, mean blood pressure decreased to 131.4/78.0 mmHg and was <130/80 mmHg in 32.9% of subjects and <140/90 mmHg in 80.2%. Over a mean follow-up of 3.2 years, age-adjusted rates of major cardiovascular events in those with mean 1-year blood pressure measurements of <130/80, 130-139/80-89, and ≥140/90 mmHg were 5.10, 4.27, and 6.94 events/1,000 person-years, respectively (P = 0.004). In FRS-adjusted models, rates of major cardiovascular events were significantly higher in those with mean blood pressure ≥140/90 mmHg in the first year after HT onset (rate ratio 1.30 [95% CI 1.01-1.169]; P = 0.04).
CONCLUSIONS
Failure to adequately control BP within 1 year of HT onset significantly increased the likelihood of major cardiovascular events within 3 years. Prompt control of new-onset HT in patients with diabetes may provide important short-term clinical benefits.