JCEM：血压与中风风险之间呈U字形相关

在糖尿病患者中，控制血压（BP）可以降低中风的风险；然而，在糖尿病患者中间，最低的中风风险的是否伴随最低的血压水平仍不清除。在路易斯安那州立大学以医院为基础纵向研究的糖尿病患者中间，为了探讨不同血压水平与中风风险之间的种族特异性关系，来自美国路易斯安那州彭宁顿生物医学研究中心的Gang Hu教授及其团队进行了一项研究，该研究发现血压与中风风险之间呈U字形相关，在非裔美国人和白人2型糖尿病患者中间，积极的血压控制（＜110/65mmHg）和高血压（≥160/100 mmHg)与中风风险增加有关。该研究结果在线发表在2013年5月28日的《临床内分泌代谢杂志》（The journal of clinical endocrinology & metabolism）杂志上。

该研究在路易斯安那州立大学（LSU）医院系统内的17536例非裔美国人和12618例白人糖尿病患者中间，前瞻性的调查基线血压不同水平与平均6.7年随访期间发生中风风险的种族特异性关系。主要观察指标是2013年5月31日之前发生的中风。

该研究结果表明，在随访期间确定了2949例发生中风的病例。基线不同收缩压/舒张压水平（＜110/65、110–119/65–69、120–129/70–80[参照组]、130–139/80–90mmHg、140–159/90–100、和≥160/100mmHg）相关的中风多变量校正风险比（HRs）在非裔美籍糖尿病患者分别为1.88 (95%可信区间[CI] 1.38–2.56), 1.05 (0.80–1.42), 1.00, 1.05 (0.86–1.27), 1.12 (0.94–1.34)，以及1.47 (1.24–1.75)，而在白人糖尿病患者分别为1.42 (1.06–1.91), 1.22 (0.95–1.57), 1.00, 0.88 (0.72–1.06), 1.02 (0.86–1.21), 以及1.28 (1.07–1.54)。在非裔美籍和白人糖尿病患者中间，观察到基线单独的收缩压和舒张压与随访期间中风风险呈U字形相关（P＜0.001）。在服用和未服用抗高血压药物的患者中，都证实了这种U字形相关。

该研究发现，血压与中风风险之间呈U字形相关，在非裔美国人和白人2型糖尿病患者中间，积极的血压控制（＜110/65mmHg）和高血压（≥160/100 mmHg)与中风风险增加有关。

Blood Pressure and Stroke Risk among Diabetic Patients.
Abstract
Context:Blood pressure (BP) control can reduce the risk of stroke among diabetic patents, however, it is not known if the lowest risk of stroke is among diabetic patients with the lowest BP level.Objective:To investigate the race-specific association of different levels of BP with stroke risk among diabetic patients in the Louisiana State University Hospital-based Longitudinal study.Design, setting, and participants:We prospectively investigated the race-specific association of different levels of blood pressure at baseline and during an average of 6.7 years of follow-up with incident stroke risk among 17,536 African American and 12,618 White diabetic patients within the Louisiana State University (LSU) Hospital System.Main Outcome Measure:Incident stroke until May 31, 2012.Results:During follow up, 2,949 incident cases of stroke were identified. The multivariable-adjusted hazard ratios (HRs) of stroke associated with different levels of systolic/diastolic blood pressure at baseline (<110/65, 110-119/65-69, 120-129/70-80 [reference group], 130-139/80-90, 140-159/90-100, and ≥160/100 mmHg) were 1.88 (95% confidence interval [CI] 1.38-2.56), 1.05 (0.80-1.42), 1.00, 1.05 (0.86-1.27), 1.12 (0.94-1.34), and 1.47 (1.24-1.75) for African American diabetic patients, and 1.42 (1.06-1.91), 1.22 (0.95-1.57), 1.00, 0.88 (0.72-1.06), 1.02 (0.86-1.21), and 1.28 (1.07-1.54) for white diabetic patients, respectively. A U-shaped association of isolated systolic or diastolic blood pressure at baseline and during follow-up with stroke risk was observed among both African American and white diabetic patients. The U-shaped association was confirmed in both patients who were and were not taking antihypertensive drugs.Conclusions:The current study suggests a U-shaped association between blood pressure and the risk of stroke. Aggressive BP control (<110/65 mmHg) and high blood pressure (≥160/100 mmHg) are associated with an increased risk of stroke among both African American and white patients with type 2 diabetes.