| Objective: To investigate the application value of simplified oral glucose tolerance test(OGTT) in hypertension combined abnormal glucose metabolism with no history of abnormal glucose metabolism. To determine the best cutoff points of fasting plasma glucose(FPG), 2-hour postprandial blood glucose(2-h PG) and Hb A1 c to screen abnormal glucose metabolism in subjects of hypertension.Method: From June 2013 to January 2016, the clinical data and glucose metabolism indexes of 427 patients with essential hypertension and 121 patients without hypertension who were free of abnormal glucose metabolism at baseline and hospitalized in the First Affiliated Hospital of Fujian Medical University were analyzed retrospectively. According to the result of FPG and simplified OGTT, both hypertensive patients and those of normal blood pressure were divided into three groups: normal blood glucose group, pre-diabetics group and diabetes group. Analyse the difference incidence rate of abnormal glucose metabolism between hypertension and normotension group. Analyse the correlations between a variety of target organ damages and FPG, 2-h PG, Hb A1 c, plasma glucose of 2 hours post glucose-load, status of glucose metabolism. The usage percentage of various medicine was compared among subgroups in hypertensive patients. With the receiver operating characteristic(ROC) curve, the best cutoff points of FPG, 2-h PG and Hb A1 c for screening abnormal glucose metabolism in hypertensive patients were obtained.Result:(1) This study included 427 hypertensive patients(250 male, 177 female), age 29~88(62.13±10.84), and 121 non-hypertensive patients(76 male, 177 female), age 30~84(57.28±9.99). Age, body mass index, microalbuminuria, D dimer, triglyceride, FPG, 2-h PG, Hb A1 c, left atrium dimension, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass index, intima-media thickness, the percentage of left ventricular hypertrophy, the percentage of carotid plaque and the prehospital usage percentage of statin were significantly higher in hypertension group than in normotension group, total cholesterol and low density lipoprotein cholesterol were significantly lower in hypertension group than in normotension group(p<0.05).(2) After simplified OGTT, 157(35.8%) new cases of impaired glucose tolerance(IGT) and 153(35.8%) new cases of diabetes mellitus(DM) was diagnosed in hypertension group, 46(38%) new cases of IGT and 13(10.7%) new cases of DM was diagnosed in normotension group. Without OGTT, 35.8% IGT and 35.8% DM will be missed diagnosed in hypertensive patients, 38% IGT and 10.7% DM will be missed diagnosed in those without hypertension. Plasma glucose of 2 hours post glucose-load(p=0.001) and the incidence of abnormal glucose metabolism(p<0.05) was significantly higher in subjects of hypertension than in those of normal blood pressure.(3) In hypertension group, total cholesterol, triglyceride and low density lipoprotein cholesterol were significantly higher in prediabetic group than in normal blood glucose group, triglyceride and uric acid were significantly higher in diabetes group than in normal blood glucose group, high density lipoprotein cholesterol was significantly lower in diabetes group than in normal blood glucose group(p<0.05).(4) The levels of FPG and 2-h PG were irrelative to whether patients with coronary heart disease, left ventricular hypertrophy, carotid lesions or not(p>0.05). Compared with subjects without hypertension, coronary heart disease and left ventricular hypertrophy, Hb A1 c, plasma glucose of 2 hours post glucose-load and the morbidity rate of abnormal glucose metabolism were significantly higher in subjects with hypertension whether they had coronary heart disease, left ventricular hypertrophy or not(p<0.05). Compared with subjects without hypertension and carotid lesions, the morbidity rate of abnormal glucose metabolism was significantly higher in subjects with hypertension combined carotid plaque or increased carotid intima-media thickness(p<0.05).(5) After adjustment medicine according to the condition in hospital, in hypertension group, the usage percentages of ACEI/ARB(p=0.001), diuretics(p=0.009) and aspirin(p=0.009) were significantly higher in diabetes group than in normal blood glucose group, the usage percentage of ACEI/ARB was significantly higher in diabetes group than in prediabetic group(p=0.008).(6) The best cutoff points for using simplified OGTT to screen abnormal glucose metabolism in hypertensive patients were as follows: FPG was 5.365mol/L, Youden index was 0.365, and the area under the curve was 0.703(95%CI: 0.611-0.795); 2-h PG was 6.850mmol/L, Youden index was 0.308, and the area under the curve was 0.688(95%CI: 0.589-0.787); Hb A1 c was 5.95%, Youden index was 0.417, and the area under the curve was 0.754(95%CI: 0.671-0.838).Conclusion: The incidence of abnormal glucose metabolism was significantly higher in subjects of hypertension than in those of normal blood pressure. Without simplified OGTT, the rate of missed diagnosis in abnormal glucose metabolism hypertensive patients was high. To achieve successful controlling of blood pressure and reducing the risk of cardiovascular events, the usage percentages of ACEI/ARB, diuretics and aspirin were significantly higher in hypertensive patients with diabetes than in those of normal blood glucose, the usage percentage of ACEI/ARB was significantly higher in hypertensive patients with diabetes than in those with prediabetes. Hb A1 c, 2-h PG, FPG had predictive value for abnormal glucose metabolism. The cutoff point for using OGTT to screen abnormal glucose metabolism in hypertensive patients were as follows: FPG was 5.365mol/L, 2-h PG was 6.850mmol/L, Hb A1 c was 5.95%. |
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