医学
血压
内科学
糖尿病
脉冲压力
2型糖尿病
心脏病学
比例危险模型
前瞻性队列研究
队列
队列研究
平均动脉压
内分泌学
心率
作者
Yi‐Ting Hsieh,Shih‐Te Tu,Tzu-Jung Cho,Shun‐Jen Chang,Jung‐Fu Chen,Ming‐Chia Hsieh
标识
DOI:10.1111/j.1365-2362.2011.02574.x
摘要
Elevations in blood pressure and visit-to-visit variability have been found to significantly increase the risk of cardiovascular morbidity and mortality in nondiabetic individuals. This study has assessed the association between all-cause mortality and blood pressure parameters [systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP) and visit-to-visit variability] in patients with type 2 diabetes.A longitudinal cohort study of 2161 patients with type 2 diabetes and a mean follow-up period of 66·7 ± 7·5 months. Using Cox regression models, blood pressure parameters were related to the risk of all-cause mortality.Visit-to-visit variability in SBP [HR: 1·048 (95% CI: 1·005-1·092; P = 0·03)], DBP [HR: 1·090 (95% CI: 1·021-1·163; P = 0·01)] and MAP [HR: 1·099 (95% CI: 1·033-1·170; P = 0·003)] significantly predicted all-cause mortality in patients with type 2 diabetes after adjusting for baseline data, mean follow-up blood pressure profiles and HbA1c. Visit-to-visit variability in PP [HR: 1·139 (95% CI: 1·030-1·258; P = 0·01)] significantly predicted cardiovascular mortality. Neither baseline nor follow-up SBP, DBP, PP nor MAP was significantly associated with all-cause and cardiovascular mortality after adjusting for blood pressure variability. The risk of all-cause mortality with a mean follow-up SBP has a U-shaped distribution. Patients with a mean follow-up DBP > 90 mmHg were at higher risk of mortality than those with DBP < 90 mmHg.Visit-to-visit variability in blood pressure was significantly associated with all-cause mortality independent of mean BP in patients with type 2 diabetes. The data for blood pressure variability might be regarded as a potentially important therapeutic target in the management of type 2 diabetes.
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