Glucose Metabolic Status In Elderly Patients With Essential And The Relationship Between On-treatment Blood Pressure And Cardiovascular And Cerebrovascular Events In Essential Hypertensive Patients With Diabetes

Objective:There is a high proportion of abnormal glucose metabolism in essential hypertension patients.The objective is to analyze the glucose metabolism status in this essential hypertensive population,the risk factors of abnormal glucose metabolism and the association between essential hypertension and diabetes.This study was undertaken to estimate clinical characteristics and associated cardiovascular risk profiles in hypertentive patients with impaired glucose regulation.China is of high morbidity of morbidity of heart diseases.Blood pressure(BP)is the most important preventable risk factor for cardiovascular(CV)diseases.Then are BP levels the lower the better?It was still in dispute.Our aim was to investigate which BP levels are best to prevent cardiovascular death in olderly hypertensive patients with diabetes.Method:1.Subjects:There were 846 elderly patitents with hypertension in cardres sanitaviums under investigation in 2003.Inclusion criteria:1)age?65y 2)antihypertensive therapy for three months and over 3)cooperate with the inspection.Exclusion criteria:1)age<60y 2)without hypertension 3)without antihypertensive therapy or antihypertensive therapy less than 3 months 4)without cooperation 5)severe valvular heart disease and cardiomyopathy.2.It was prospective study from 2003-1 to 2010.A questionnaire called "The cardio-cerebralvascular disease and risk factors survey" was developed.Face-to-face interviews or inteviews by phones were employed in the investigations,or consultation with care physicians.3.Patients were categorized into five groups by their average on-treatment systolic BP(SBP)was respectively classified into 5 levels:?130mmHg,130?140 mmHg,?140mmHg;4.Statistical methods:SPSS20.0 software was adopted to analyze the data.Numerical variable were assessed by one-way ANOVA.Values were recorded as mean±standard deviation.Count information were expressed as sample rate,and assessed by Chi-square test.mode.Analyze the risk factors of impaired glucose regulation(IGR)and diabetes in essential hypertension patients by Logistic regression mode.The relationship between cardio-cerebralvascular diseases and risk factors was evaluated by COX regression analysis.If P<0.05,it was statistically significant.5.To research the relationship between on-treatment blood pressure and cardiovascular and cerebrovascular events in essential hypertensive patients with diabetes,232 eldly primary hypertensives patients with diabetes is elected in the study.Patients were categorized into five groups by their average on-treatment systolic BP(?130 mmHg,130-140 mmHg,>140 mmHg).The rate of total all-cause mortality and cardiovascular death were compared among BP groups using Kaplan-Meier plots and Cox proportional hazard regression model with BP groups of 130-140mm Hg as the reference respectively.Statistical methods:SPSS20.0 software was adopted to analyze the data.Numerical variable were assessed by one-way ANOVA.Values were recorded as mean ? standard deviation.Count information were expressed as sample rate,and assessed by Chi-square test mode.The rate of total all-cause mortality and cardiovascular death were compared among BP groups using Kaplan-Meier plots and Cox proportional hazard regression model with BP groups of 130-140mm Hg as the reference respectively.If P<0.05,it was statistically significant.Result:1.In 846 subjects with hypertension(714men)mean age74.49 years old,255 subjects have impaired glucose metabolism,285 have DM,42 have IFG,126 have IGT and 87 have IFG+IGT;The detection rate of hypertension with impaired glucose metabolism was 33.7%.2.TG(OR=1.235,95%CI 1.012?1.509 P=0.038)?age(OR=1.036,95%CI 1.006?1.068 P=0.018)?smoke(OR=1.207,95%CI 1.013?1.439 P=0.035)are risk factors of diabetes for hypertension patients.3.In comparing with NGT group,the risk of all-cause mortality was significantly higher in the DM group(HR,2.506;95%CI,1.763?3.563;P=0.001);In comparing with NGT group,the risk of cardiovascular death and cerebrovascular mortality was significantly higher in the IRG group(HR,1.563;95%CI,1.068?2.287;P=0.022).4.In 232 patients,the number of all-cause mortality is 76,and the ratio of events:cardiovascular death(39.47%,30/76).Proportion of cardiovascular death and cerebrovascular mortality in 130?140 mmHg hypertensive patients with diabetes was significantly lower than the other groups.The proportion of all-cause mortality is 28%.The proportion of cardiovascular death is 12%.5.A total of 150 all-cause mortality occurred in the 232 essential hypertensive patients with diabetes.A J-shaped relationship between BP and cardiovascular death and cerebrovascular mortality was found.In comparing with the systolic BP of 130 to<140 mm Hg group,the risk of all-cause mortality was significantly higher in the>140mmHg group(adjusted HR,1.521;95%CI,1.07-2.0431;P=0.028));was significantly higher in the?130mmHg group(adjusted HR,,1.521;95%CI,1.05-2.71;P=0.015);In comparing with the systolic BP of 130 to<140 mm Hg group,the risk of cardiovascular death and cerebrovascular mortality was significantly higher in the>140mmHg group(adjusted HR,1.826;95%CI,1.046-3.532;P=0.033);was significantly higher in the ? 130mmHg group(adjusted HR,1.775;95%CI,1.058-3.157;P=0.018).Conclusions:1.In 846 subjects with hypertension(502 men)mean age74.49 years old,255 subjects have impaired glucose metabolism,285 have DM,42 have IFG,126 have IGT and 87 have IFG+IGT;The detection rate of hypertension with impaired glucose metabolism was 33.7%.2.Poorly controlled blood pressure is associated with increased plasma glucose.3.Age?cardiovascular risk stratification?DMin elderly hypertensive population were risk factors of all-cause mortality.Age?cardiovascular risk stratification?hyperlipemia are riskfactors for cardiovascular death in elderly hypertensive population.4.To prevent all-cause mortality and cardiovascular deaths in essential hypertensive patients with diabetes,A systolic BP goal of 130 to<140 mmHg is recommended for patients aged ?65 years and with diabetes.