2 型糖尿病与高血压。
Type 2 Diabetes and Hypertension.
机构信息
From the Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (D.S., T.Z., Y.H., X.L., L.Q.).
Department of Public Health Laboratory Sciences, West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China (T.Z.).
出版信息
Circ Res. 2019 Mar 15;124(6):930-937. doi: 10.1161/CIRCRESAHA.118.314487.
RATIONALE
In observational studies, type 2 diabetes mellitus (T2D) has been associated with an increased risk of hypertension, and vice versa; however, the causality between these conditions remains to be determined.
OBJECTIVES
This population-based prospective cohort study sought to investigate the bidirectional causal relations of T2D with hypertension, systolic and diastolic blood pressure (BP) using Mendelian randomization (MR) analysis.
METHODS AND RESULTS
After exclusion of participants free of a history of heart failure, cardiovascular disease, cardiac procedures, and non-T2D diabetes mellitus, a total of 318 664 unrelated individuals with qualified genotyping data of European descent aged 37 to 73 from UK Biobank were included. The genetically instrumented T2D and hypertension were constructed using 134 and 233 single nucleotide polymorphisms, respectively. Seven complementary MR methods were applied, including inverse-variance weighted method, 2 median-based methods (simple and weighted), MR-Egger, MR-robust adjusted profile scores, MR-Pleiotropy Residual Sum and Outlier, and multivariate MR. The genetically instrumented T2D was associated with risk of hypertension (odds ratio, 1.07 [95% CI, 1.04-1.10], P=3.4×10), whereas the genetically determined hypertension showed no relationship with T2D (odds ratio, 0.96 [0.88-1.04], P=0.34). Our MR estimates from T2D to BP showed that the genetically instrumented T2D was associated with a 0.67 mm Hg higher systolic BP (95% CI, 0.41-0.93, P=5.75×10) but not with a higher diastolic BP. There was no clear evidence showing a causal effect of elevated systolic BP or diastolic BP on T2D risk. Positive pleiotropic bias was indicated in the hypertension→T2D relation (odds ratio, of MR-Egger intercept 1.010 [1.004-1.016], P=0.001) but not from T2D to hypertension (1.001 [0.998-1.004], P=0.556).
CONCLUSIONS
T2D may causally affect hypertension, whereas the relationship from hypertension to T2D is unlikely to be causal. These findings suggest the importance of keeping an optimal glycemic profile in general populations, and BP screening and monitoring, especially systolic BP, in patients with T2D.
背景
在观察性研究中，2 型糖尿病（T2D）与高血压的风险增加有关，反之亦然；然而，这些疾病之间的因果关系仍有待确定。
目的
本基于人群的前瞻性队列研究旨在使用孟德尔随机化（MR）分析探讨 T2D 与高血压、收缩压和舒张压（BP）之间的双向因果关系。
方法和结果
在排除了无心力衰竭、心血管疾病、心脏手术和非 T2D 糖尿病病史的参与者后，从英国生物库中纳入了 318664 名年龄在 37 至 73 岁之间、具有合格基因分型数据的欧洲血统的无关联个体。使用 134 个和 233 个单核苷酸多态性分别构建了遗传工具化的 T2D 和高血压。应用了 7 种互补的 MR 方法，包括逆方差加权法、2 种基于中位数的方法（简单和加权）、MR-Egger、MR-稳健调整的评分、MR-Pleiotropy Residual Sum and Outlier，以及多变量 MR。遗传工具化的 T2D 与高血压风险相关（比值比，1.07[95%CI，1.04-1.10]，P=3.4×10），而遗传确定的高血压与 T2D 无关（比值比，0.96[0.88-1.04]，P=0.34）。我们从 T2D 到 BP 的 MR 估计表明，遗传工具化的 T2D 与收缩压升高 0.67mmHg 相关（95%CI，0.41-0.93，P=5.75×10），但与舒张压升高无关。没有明确的证据表明升高的收缩压或舒张压与 T2D 风险之间存在因果关系。在高血压→T2D 关系中存在阳性的偏倚（MR-Egger 截距的比值比为 1.010[1.004-1.016]，P=0.001），但从 T2D 到高血压的关系中没有（1.001[0.998-1.004]，P=0.556）。
结论
T2D 可能会对高血压产生因果影响，而高血压对 T2D 的影响则不太可能是因果关系。这些发现表明，在一般人群中保持最佳血糖谱以及在 T2D 患者中进行血压筛查和监测（特别是收缩压）非常重要。
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