血壓和2型糖尿病風險的可靠量化相關性證據尚缺乏。英國學者針對上述問題開展了一項前瞻性研究的薈萃分析，結果表明，血壓升高的人群罹患糖尿病的風險增加。隨著體質指數(BMI)和年齡的增加，這種相關性的強度下降。相關文章近期發表於《美國心髒病學會雜誌》(簡稱JACC)。
研究者們利用經過驗證的電子健康記錄識別了410萬無糖尿病和心血管疾病的成人受試者，輔以報告每單位收縮壓下新發糖尿病相對風險的前瞻性研究薈萃分析。
結果顯示，在所有隊列中，收縮壓升高20 mm Hg和舒張壓升高10 mm Hg分別與新發糖尿病風險增加58%和52%有關[危險比分別為：1.58和1.52;95%置信區間(CI)分別為1.56 -1.59和1.51 -1.54]。沒有最低點至110/70 mm Hg基線血壓的證據。收縮壓每升高20 mm Hg的相關性強度隨著年齡和BMI的增加而下降。即使是在排除服用降壓藥或進行降脂治療的個體後，其相關性概率也相似。係統回顧識別了30項研究中的285664例受試者和17388例糖尿病事件。常規收縮壓升高20 mm Hg的糖尿病彙集相對風險為1.77 。
參考文獻：Connor A. Emdin, et al. J Am CollCardiol. 2015;66(14):1552-1562. doi:10.1016/j.jacc.2015.07.059
Usual Blood Pressure and Risk of New-Onset Diabetes
Evidence From 4.1 Million Adults and a Meta-Analysis of Prospective Studies
Commentary by Dr. Fuster
Connor A. Emdin, HBSc∗; Simon G. Anderson, PhD∗,†; Mark Woodward, PhD∗,‡; KazemRahimi, DM, MSc∗,§
[+] Author Information
∗ The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
† Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
‡ The George Institute for Global Health, University of Sydney, Sydney, Australia
§ Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
J Am CollCardiol. 2015;66(14):1552-1562. doi:10.1016/j.jacc.2015.07.059
Background Reliable quantification of the association between blood pressure (BP) and risk of type 2 diabetes is lacking.
Objectives This study sought to determine the association between usual BP and risk of diabetes, overall and by participant characteristics.
Methods A cohort of 4.1 million adults, free of diabetes and cardiovascular disease, was identified using validated linked electronic health records. Analyses were complemented by a meta-analysis of prospective studies that reported relative risks of new-onset diabetes per unit of systolic blood pressure (SBP).
Results Among the overall cohort, 20 mm Hg higher SBP and 10 mm Hg higher diastolic BP were associated with a 58% and a 52% higher risk of new-onset diabetes (hazard ratio: 1.58; 95% confidence interval [CI]: 1.56 to 1.59; and hazard ratio: 1.52; 95% confidence interval: 1.51 to 1.54), respectively. There was no evidence of a nadir to a baseline BP of 110/70 mm Hg. The strength of the association per 20 mm Hg higher SBP declined with age and with increasing body mass index. Estimates were similar even after excluding individuals prescribed antihypertensive or lipid-lowering therapies. Systematic review identified 30 studies with 285,664 participants and 17,388 incident diabetes events. The pooled relative risk of diabetes for a 20 mm Hg higher usual SBP across these studies was 1.77 (1.53 to 2.05).
Conclusions People with elevated BP are at increased risk of diabetes. The strength of the association declined with increasing body mass index and age. Further research should determine if the observed risk is modifiable.
