論文

査読有り 国際誌
2019年4月16日

Pulse Pressure is a Stronger Predictor Than Systolic Blood Pressure for Severe Eye Diseases in Diabetes Mellitus.

Journal of the American Heart Association
  • Masahiko Yamamoto
  • ,
  • Kazuya Fujihara
  • ,
  • Masahiro Ishizawa
  • ,
  • Taeko Osawa
  • ,
  • Masanori Kaneko
  • ,
  • Hajime Ishiguro
  • ,
  • Yasuhiro Matsubayashi
  • ,
  • Hiroyasu Seida
  • ,
  • Nauta Yamanaka
  • ,
  • Shiro Tanaka
  • ,
  • Satoru Kodama
  • ,
  • Hiruma Hasebe
  • ,
  • Hirohito Sone

8
8
開始ページ
e010627
終了ページ
記述言語
英語
掲載種別
DOI
10.1161/JAHA.118.010627

Background Evidence of the role of systolic blood pressure ( SBP ) in development of severe diabetic retinopathy is not strong, although the adverse effect of low diastolic blood pressure has been a partial explanation. We assessed the predictive ability of incident severe diabetic retinopathy between pulse pressure ( PP ) which considers both SBP and diastolic blood pressure, compared with SBP . Methods and Results Eligible patients (12 242, 83% men) aged 19 to 72 years from a nationwide claims database were analyzed for a median observational 4.8-year period. Severe diabetic retinopathy was defined as vision-threatening treatment-required diabetic eye diseases. Multivariate Cox regression analysis revealed that hazard ratios (95% CI ) of treatment-required diabetic eye diseases for 1 increment of standard deviation and the top tertile compared with the bottom tertile were 1.39 (1.21-1.60) and 1.72 (1.17-2.51), respectively, for PP and 1.22 (1.05-1.41) and 1.43 (0.97-2.11), respectively, for SBP adjusted for age, sex, body mass index, hemoglobin A1c, fasting plasma glucose, lipids, and smoking status. In a model with SBP and PP simultaneously as covariates, the hazard ratios of only PP (hazard ratios [95% CI ], 1.57 [1.26-1.96]) but not SBP (0.85 [0.68-1.07]) were statistically significant. Delong test revealed a significant difference in the area under the receiver operating characteristic curve between PP and SBP (area under the receiver operating characteristic curve [95% CI ], 0.58 [0.54-0.63] versus 0.54 [0.50-0.59]; P=0.03). The strongest predictor remained as hemoglobin A1c (area under the receiver operating characteristic curve [95% CI ], 0.80 [0.77-0.84]). Conclusions After excluding the significant impact of glycemic control, PP in comparison with SBP is a better predictor of severe diabetic retinopathy, suggesting a role of diastolic blood pressure and arterial stiffness in pathology.

リンク情報
DOI
https://doi.org/10.1161/JAHA.118.010627
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/30971163
PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6507184

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