高血压人群脉压与新发糖尿病的关系探讨

Association between pulse pressure and new-onset diabetes in hypertensive patients

目的探讨脉压对高血压人群新发糖尿病的影响。方法该研究为前瞻性队列研究,选取开滦研究中参加2006年至2007年健康体检且后续进行了随访的原发性高血压患者作为研究对象,以完成2006年至2007年健康体检时间点作为随访起点,以新发糖尿病作为终点事件,2016年至2017年体检时间为末次随访时间。按脉压四分位将研究对象分为4组,即Q1组、Q2组、Q3组和Q4组。采用Kaplan-Meier生存曲线分析各脉压组新发糖尿病的累积发生率,采用Cox回归模型分析基线脉压对高血压人群新发糖尿病的影响。结果研究最终纳入32917位研究对象,随访(8.17±2.99)年,随访期间新发糖尿病6617例(19.31%),研究人群中Q1组7995例[脉压<41 mmHg(1 mmHg=0.133kPa)]、Q2组8196例(脉压41-<51 mmHg)、Q3组8270例(脉压51-<61 mmHg)、Q4组8456例(脉压≥61 mmHg),各组人群新发糖尿病累积发病率分别为16.94%、19.61%、21.07%、22.33%,发病密度分别为20.27、23.20、24.92、26.10/千人年,新发糖尿病的累积发病率随着脉压的升高而上升(χ^(2)=50.35,P<0.01)。多因素Cox回归分析结果显示,校正混杂因素后Q3组和Q4组高血压患者新发糖尿病风险分别是Q1组的1.13(95%CI 1.04-1.22,P<0.01)、1.14(95%CI 1.05-1.24,P<0.01)倍,脉压/平均动脉压比值每增加1个标准差(0.13),新发糖尿风险增加5%(HR=1.05,95%CI 1.02-1.08,P<0.01)。敏感性分析结果与主要研究结果趋势一致。结论脉压与高血压人群新发糖尿病发病率呈正相关,高脉压是高血压人群新发糖尿病的独立危险因素。

Objective To determine the association between pulse pressure and the risk of new-onset diabetes in hypertensive patients.Methods In this prospective cohort study,hypertensive patients from the Kailuan Study,who were diagnosed in 2006-2007 check-up,were screened for enrollment.Participants who finished the biennial follow-up until December 31,2017 were finally included in this analysis.The primary outcome was incident diabetes development.The pulse pressure variables were divided into quartiles(Q1-Q4),and the Kaplan-Meier curve was used to examine and estimate the cumulative incidence of new-onset diabetes among quartiles.Cox proportional hazards regression model was performed to explore the association between pulse pressure and the risk of new-onset diabetes in hypertensive patients.Results During an average follow-up of 8.17 years,6617 new-onset diabetes were identified out of the 32917 hypertensive patients with no history or evidence of diabetes in 2006-2007 check-up.Participants were classified into quartiles according to pulse pressure levels as follows:Q1 group(<41 mmHg(1mmHg=0.133kPa))(n=7995);Q2 group(41-<51 mmHg)(n=8196);Q3 group(51-<61 mmHg)(n=8270);Q4 group(≥61 mmHg)(n=8456).The cumulative incidences of new-onset diabetes across the quartiles were 16.94%,19.61%,21.07%,and 22.33%,respectively,with the incidence density was 20.27,23.20,24.92,and 26.10 per 1000 person-years,respectively.The cumulative incidence of new-onset diabetes increased in proportion with increasing pulse pressure levels(P<0.01 by the Log-rank test).After multivariate adjustment,compared with the first quartile,the hazard ratios for new-onset diabetes in the third and fourth quartiles were 1.13(95%CI 1.04-1.22,P<0.01)and 1.14(95%CI 1.05-1.24,P<0.01),respectively.The risk of new-onset diabetes increased 5%(HR=1.05,95%CI 1.02-1.08,P<0.01)with the fractional pulse pressure increased per 1 SD(0.13).Findings from the three sensitivity analyses were consistent with the main results in this cohort.Conclusions Pulse pressure at baseline is positively associated with the incidence of new-onset diabetes among hypertensive individuals,and pulse pressure is an independent risk factor for the development of diabetes in hypertensive patients.