血压和2型 风险的可靠量化相关性证据尚缺乏。英国学者针对上述问题开展了一项前瞻性研究的荟萃分析，结果表明，血压升高的人群罹患 的风险增加。随着体质指数(BMI)和年龄的增加，这种相关性的强度下降。相关文章近期发表于《美国心脏病学会杂志》(简称JACC)。

研究者们利用经过验证的电子健康记录识别了410万无 和心血管疾病的成人受试者，辅以报告每单位收缩压下新发 相对风险的前瞻性研究荟萃分析。

结果显示，在所有队列中，收缩压升高20 mm Hg和舒张压升高10 mm Hg分别与新发 风险增加58%和52%有关[危险比分别为：1.58和1.52;95%置信区间(CI)分别为1.56 -1.59和1.51 -1.54]。没有最低点至110/70 mm Hg基线血压的证据。收缩压每升高20 mm Hg的相关性强度随着年龄和BMI的增加而下降。即使是在排除服用降压药或进行降脂治疗的个体后，其相关性概率也相似。系统回顾识别了30项研究中的285664例受试者和17388例 事件。常规收缩压升高20 mm Hg的 汇集相对风险为1.77 。

参考文献：Connor A. Emdin, et al. J Am CollCardiol. 2015;66(14):1552-1562. doi:10.1016/j.jacc.2015.07.059

Usual Blood Pressure and Risk of New-Onset Diabetes
Evidence From 4.1 Million Adults and a Meta-Analysis of Prospective Studies
Commentary by Dr. Fuster

Connor A. Emdin, HBSc∗; Simon G. Anderson, PhD∗,†; Mark Woodward, PhD∗,‡; KazemRahimi, DM, MSc∗,§
[+] Author Information
∗ The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
† Cardiovascular Research Group, Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
‡ The George Institute for Global Health, University of Sydney, Sydney, Australia
§ Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
J Am CollCardiol. 2015;66(14):1552-1562. doi:10.1016/j.jacc.2015.07.059
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.