期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 66, 期 14, 页码 1552-1562出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2015.07.059
关键词
body mass index; meta-analysis; regression dilution bias
资金
- U.K. National Institute for Health Research
- Rhodes Trust
- National Institute of Health Research
- Australian Health and Medical Research Council
- Oxford Martin School
- National Institute of Health Research Oxford Biomedical Research Centre
- National Institute of Health Research Career Development Fellowship
- National Institute for Health Research [CL-2012-06-001] Funding Source: researchfish
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. (C) 2015 by the American College of Cardiology Foundation.
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