PDF(Pubmed)
Abstract：
OBJECTIVE: Guidelines suggest similar blood pressure (BP) targets in patients with and without diabetes and recommend ambulatory BP monitoring (ABPM) to diagnose and classify hypertension. It was explored whether different levels of ambulatory and office BP and different hypertension phenotypes associate with differences of risk in diabetes and no diabetes.
METHODS: This analysis assessed outcome data from the Spanish ABPM Registry in 59 124 patients with complete available data. The associations between office, mean, daytime, and nighttime ambulatory BP with the risk in patients with or without diabetes were explored. The effects of diabetes on mortality in different hypertension phenotypes, i.e. sustained hypertension, white-coat hypertension, and masked hypertension, compared with normotension were studied. Analyses were done with Cox regression analyses and adjusted for demographic and clinical confounders.
RESULTS: A total of 59 124 patients were recruited from 223 primary care centres in Spain. The majority had an office systolic BP >140 mmHg (36 700 patients), and 23 128 (40.6%) patients were untreated. Diabetes was diagnosed in 11 391 patients (19.2%). Concomitant cardiovascular (CV) disease was present in 2521 patients (23.1%) with diabetes and 4616 (10.0%) without diabetes. Twenty-four-hour mean, daytime, and nighttime ambulatory BP were associated with increased risk in diabetes and no diabetes, while in office BP, there was no clear association with no differences with and without diabetes. While the relative association of BP to CV death risk was similar in diabetes compared with no diabetes (mean interaction P = .80, daytime interaction P = .97, and nighttime interaction P = .32), increased event rates occurred in diabetes for all ABPM parameters for CV death and all-cause death. White-coat hypertension was not associated with risk for CV death (hazard ratio 0.86; 95% confidence interval 0.72-1.03) and slightly reduced risk for all-cause death in no diabetes (hazard ratio 0.89; confidence interval 0.81-0.98) but without significant interaction between diabetes and no diabetes. Sustained hypertension and masked hypertension in diabetes and no diabetes were associated with even higher risk. There were no significant interactions in hypertensive phenotypes between diabetes and no diabetes and CV death risk (interaction P = .26), while some interaction was present for all-cause death (interaction P = .043) and non-CV death (interaction P = .053).
CONCLUSIONS: Diabetes increased the risk for all-cause death, CV, and non-CV death at every level of office and ambulatory BP. Masked and sustained hypertension confer to the highest risk, while white-coat hypertension appears grossly neutral without interaction of relative risk between diabetes and no diabetes. These results support recommendations of international guidelines for strict BP control and using ABPM for classification and assessment of risk and control of hypertension, particularly in patients with diabetes.
BACKGROUND: Not applicable.
METHODS: This analysis assessed outcome data from the Spanish ABPM Registry in 59 124 patients with complete available data. The associations between office, mean, daytime, and nighttime ambulatory BP with the risk in patients with or without diabetes were explored. The effects of diabetes on mortality in different hypertension phenotypes, i.e. sustained hypertension, white-coat hypertension, and masked hypertension, compared with normotension were studied. Analyses were done with Cox regression analyses and adjusted for demographic and clinical confounders.
RESULTS: A total of 59 124 patients were recruited from 223 primary care centres in Spain. The majority had an office systolic BP >140 mmHg (36 700 patients), and 23 128 (40.6%) patients were untreated. Diabetes was diagnosed in 11 391 patients (19.2%). Concomitant cardiovascular (CV) disease was present in 2521 patients (23.1%) with diabetes and 4616 (10.0%) without diabetes. Twenty-four-hour mean, daytime, and nighttime ambulatory BP were associated with increased risk in diabetes and no diabetes, while in office BP, there was no clear association with no differences with and without diabetes. While the relative association of BP to CV death risk was similar in diabetes compared with no diabetes (mean interaction P = .80, daytime interaction P = .97, and nighttime interaction P = .32), increased event rates occurred in diabetes for all ABPM parameters for CV death and all-cause death. White-coat hypertension was not associated with risk for CV death (hazard ratio 0.86; 95% confidence interval 0.72-1.03) and slightly reduced risk for all-cause death in no diabetes (hazard ratio 0.89; confidence interval 0.81-0.98) but without significant interaction between diabetes and no diabetes. Sustained hypertension and masked hypertension in diabetes and no diabetes were associated with even higher risk. There were no significant interactions in hypertensive phenotypes between diabetes and no diabetes and CV death risk (interaction P = .26), while some interaction was present for all-cause death (interaction P = .043) and non-CV death (interaction P = .053).
CONCLUSIONS: Diabetes increased the risk for all-cause death, CV, and non-CV death at every level of office and ambulatory BP. Masked and sustained hypertension confer to the highest risk, while white-coat hypertension appears grossly neutral without interaction of relative risk between diabetes and no diabetes. These results support recommendations of international guidelines for strict BP control and using ABPM for classification and assessment of risk and control of hypertension, particularly in patients with diabetes.
BACKGROUND: Not applicable.
摘要：
目的：指南建议糖尿病患者和非糖尿病患者的血压（BP）目标相似，并建议动态血压监测（ABPM）来诊断和分类高血压。探讨了不同的门诊和办公室血压水平以及不同的高血压表型是否与糖尿病和非糖尿病的风险差异有关。
方法：本分析评估了来自西班牙ABPM注册中心的59124例患者的结果数据，这些患者具有完整的可用数据。办公室之间的联系，意思是，白天,并探讨了有或无糖尿病患者的夜间动态血压与风险的关系。糖尿病对不同高血压表型死亡率的影响,即持续的高血压，白大衣高血压，和掩盖的高血压，与正常值进行了比较研究。使用Cox回归分析进行分析，并针对人口统计学和临床混杂因素进行校正。
结果：共有59124名患者从西班牙的223个初级保健中心招募。大多数患者的办公室收缩压>140mmHg（36700名患者），23128例（40.6%）患者未接受治疗。11391例患者被诊断为糖尿病（19.2%）。2521例（23.1％）糖尿病患者和4616例（10.0％）无糖尿病患者中存在伴随心血管（CV）疾病。二十四小时平均,白天,夜间动态血压与糖尿病和非糖尿病的风险增加有关，在办公室的时候，英国石油公司，没有明确的相关性,糖尿病患者和糖尿病患者之间没有差异.糖尿病患者血压与心血管死亡风险的相关关系与无糖尿病患者相似（平均交互作用P=0.80，白天交互作用P=0.97，夜间交互作用P=0.32），对于CV死亡和全因死亡的所有ABPM参数,糖尿病事件发生率均升高.白大衣高血压与CV死亡风险无关（风险比0.86；95％置信区间0.72-1.03），无糖尿病患者全因死亡风险略有降低（风险比0.89；置信区间0.81-0.98），但糖尿病与非糖尿病之间无显著交互作用。糖尿病和无糖尿病的持续高血压和隐性高血压与更高的风险相关。在高血压表型中，糖尿病与非糖尿病与CV死亡风险之间没有显著的交互作用（交互作用P=0.26），而全因死亡（交互作用P=.043）和非CV死亡（交互作用P=.053）存在一些交互作用。
结论：糖尿病增加了全因死亡的风险，CV,以及各级办公室和门诊血压的非CV死亡。掩盖和持续的高血压赋予最高的风险，而白大衣高血压似乎是中性的，糖尿病与非糖尿病之间没有相对风险的相互作用。这些结果支持了严格BP控制和使用ABPM进行高血压风险分类和评估和控制的国际指南的建议。特别是糖尿病患者。
背景：不适用。
方法：本分析评估了来自西班牙ABPM注册中心的59124例患者的结果数据，这些患者具有完整的可用数据。办公室之间的联系，意思是，白天,并探讨了有或无糖尿病患者的夜间动态血压与风险的关系。糖尿病对不同高血压表型死亡率的影响,即持续的高血压，白大衣高血压，和掩盖的高血压，与正常值进行了比较研究。使用Cox回归分析进行分析，并针对人口统计学和临床混杂因素进行校正。
结果：共有59124名患者从西班牙的223个初级保健中心招募。大多数患者的办公室收缩压>140mmHg（36700名患者），23128例（40.6%）患者未接受治疗。11391例患者被诊断为糖尿病（19.2%）。2521例（23.1％）糖尿病患者和4616例（10.0％）无糖尿病患者中存在伴随心血管（CV）疾病。二十四小时平均,白天,夜间动态血压与糖尿病和非糖尿病的风险增加有关，在办公室的时候，英国石油公司，没有明确的相关性,糖尿病患者和糖尿病患者之间没有差异.糖尿病患者血压与心血管死亡风险的相关关系与无糖尿病患者相似（平均交互作用P=0.80，白天交互作用P=0.97，夜间交互作用P=0.32），对于CV死亡和全因死亡的所有ABPM参数,糖尿病事件发生率均升高.白大衣高血压与CV死亡风险无关（风险比0.86；95％置信区间0.72-1.03），无糖尿病患者全因死亡风险略有降低（风险比0.89；置信区间0.81-0.98），但糖尿病与非糖尿病之间无显著交互作用。糖尿病和无糖尿病的持续高血压和隐性高血压与更高的风险相关。在高血压表型中，糖尿病与非糖尿病与CV死亡风险之间没有显著的交互作用（交互作用P=0.26），而全因死亡（交互作用P=.043）和非CV死亡（交互作用P=.053）存在一些交互作用。
结论：糖尿病增加了全因死亡的风险，CV,以及各级办公室和门诊血压的非CV死亡。掩盖和持续的高血压赋予最高的风险，而白大衣高血压似乎是中性的，糖尿病与非糖尿病之间没有相对风险的相互作用。这些结果支持了严格BP控制和使用ABPM进行高血压风险分类和评估和控制的国际指南的建议。特别是糖尿病患者。
背景：不适用。
