收缩压与2型糖尿病大血管及微血管并发症的关联（英国前瞻性糖尿病研究36）：前瞻性观察研究
Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study.
作者信息
Adler A I, Stratton I M, Neil H A, Yudkin J S, Matthews D R, Cull C A, Wright A D, Turner R C, Holman R R
机构信息
Diabetes Trial Unit, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE, UK.
出版信息
BMJ. 2000 Aug 12;321(7258):412-9. doi: 10.1136/bmj.321.7258.412.
OBJECTIVE
To determine the relation between systolic blood pressure over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes.
DESIGN
Prospective observational study.
SETTING
23 hospital based clinics in England, Scotland, and Northern Ireland.
PARTICIPANTS
4801 white, Asian Indian, and Afro-Caribbean UKPDS patients, whether randomised or not to treatment, were included in analyses of incidence; of these, 3642 were included in analyses of relative risk.
OUTCOME MEASURES
Primary predefined aggregate clinical outcomes: any complications or deaths related to diabetes and all cause mortality. Secondary aggregate outcomes: myocardial infarction, stroke, lower extremity amputation (including death from peripheral vascular disease), and microvascular disease (predominantly retinal photocoagulation). Single end points: non-fatal heart failure and cataract extraction. Risk reduction associated with a 10 mm Hg decrease in updated mean systolic blood pressure adjusted for specific confounders.
RESULTS
The incidence of clinical complications was significantly associated with systolic blood pressure, except for cataract extraction. Each 10 mm Hg decrease in updated mean systolic blood pressure was associated with reductions in risk of 12% for any complication related to diabetes (95% confidence interval 10% to 14%, P<0.0001), 15% for deaths related to diabetes (12% to 18%, P<0.0001), 11% for myocardial infarction (7% to 14%, P<0.0001), and 13% for microvascular complications (10% to 16%, P<0.0001). No threshold of risk was observed for any end point.
CONCLUSIONS
In patients with type 2 diabetes the risk of diabetic complications was strongly associated with raised blood pressure. Any reduction in blood pressure is likely to reduce the risk of complications, with the lowest risk being in those with systolic blood pressure less than 120 mm Hg.
目的
确定2型糖尿病患者收缩压随时间的变化与大血管或微血管并发症风险之间的关系。
设计
前瞻性观察性研究。
地点
英格兰、苏格兰和北爱尔兰的23家医院门诊。
参与者
4801名英国糖尿病前瞻性研究（UKPDS）的白人、亚洲印度人和非洲加勒比人患者，无论是否随机接受治疗，均纳入发病率分析；其中3642名纳入相对风险分析。
观察指标
预先设定的主要总体临床结局：任何与糖尿病相关的并发症或死亡以及全因死亡率。次要总体结局：心肌梗死、中风、下肢截肢（包括因外周血管疾病死亡）和微血管疾病（主要是视网膜光凝）。单一终点：非致命性心力衰竭和白内障摘除术。针对特定混杂因素调整后的最新平均收缩压每降低10 mmHg所带来的风险降低。
结果
除白内障摘除术外，临床并发症的发生率与收缩压显著相关。最新平均收缩压每降低10 mmHg，与糖尿病相关并发症风险降低12%（95%置信区间10%至14%，P<0.0001）、糖尿病相关死亡风险降低15%（12%至18%，P<0.0001）、心肌梗死风险降低11%（7%至14%，P<0.0001）以及微血管并发症风险降低13%（10%至16%，P<0.0001）相关。未观察到任何终点的风险阈值。
结论
在2型糖尿病患者中，糖尿病并发症风险与血压升高密切相关。血压的任何降低都可能降低并发症风险，收缩压低于120 mmHg的患者风险最低。
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