Background and Rationales. Hypertensive patients with newly diagnosed diabetes are associated with heightened risks for cardiovascular events. Yet endorsement of state-of-the-art guidelines with more stringent goals poses significant challenges in obtaining multifactorial control. This study aimed to illustrate the impact of novel targets on achieving simultaneous control overtime and its association with mortality. Methods. This prospective, observational study involved adult hypertensive patients with newly diagnosed type 2 diabetes mellitus at two university hospitals in Vietnam. The median time of follow-up was 4 years (August 2016–August 2020). The primary outcome was time to all-cause mortality. Results. 246 patients were included with a mean age of 64.5 ± 10.4. 58.5% were females. 64.2% were categorized as high risk. At baseline, ischemic heart disease, dyslipidemia, and chronic kidney disease (CKD) were present in 54.9%, 67.1%, and 41.1% of patients. Renin–angiotensin–aldosterone inhibitor, metformin, and statin were prescribed in 89.8%, 66.3%, and 67.1%. Among three risk factors, LDL-c control was the hardest to achieve, increasing from 5.7% to 8.5%. In contrast, blood pressure control decreased from 56.1% in 2016 to 30.2% in 2020, when the second wave of COVID-19 hit our nation. While contemporary targets resulted in persistently low simultaneous control at 1.2%, significant improvement was observed with conventional criteria (blood pressure < 140/90 mmHg, HbA1c < 7%, LDL-c < 70 mg/dl), increasing from 14.6% to 33.7%. During follow-up, the mortality rate was 24.4 events per 1000 patient-years, exclusively in patients with early newly diagnosed diabetes. Improving control overtime, not at baseline, was associated with less mortality. Conversely, age >75 years (HR = 2.6) and CKD (HR = 4.9) were associated with increased mortality. Conclusion. These findings demonstrated real-world difficulties in managing hypertension and newly diagnosed diabetes, especially with stringent criteria from novel guidelines. High-risk profile, high mortality, and poor simultaneous control warrant more aggressive cardiorenal protection, focusing more on aging CKD patients with early newly diagnosed diabetes.

中文翻译：

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新指南对多因素控制的影响及其与成年高血压和新诊断 2 型糖尿病患者死亡率的关系：一项为期 4 年的前瞻性多中心研究

背景和理由。新诊断糖尿病的高血压患者与心血管事件的风险增加有关。然而，对具有更严格目标的最先进指南的认可对获得多因素控制提出了重大挑战。本研究旨在说明新目标对实现同时控制加班的影响及其与死亡率的关系。方法。这项前瞻性观察性研究涉及越南两所大学医院新诊断的 2 型糖尿病成人高血压患者。中位随访时间为 4 年（2016 年 8 月至 2020 年 8 月）。主要结局是全因死亡率的时间。结果。纳入 246 名患者，平均年龄为 64.5 ± 10.4 岁。58.5%为女性。64.2%被归类为高风险。基线时，54.9%、67.1% 和 41.1% 的患者存在缺血性心脏病、血脂异常和慢性肾脏病 (CKD)。89.8%、66.3% 和 67.1% 的患者服用肾素-血管紧张素-醛固酮抑制剂、二甲双胍和他汀类药物。在三个危险因素中，LDL-c控制是最难实现的，从5.7%增加到8.5%。相比之下，血压控制率从 2016 年的 56.1% 下降到 2020 年第二波 COVID-19 袭击我国时的 30.2%。虽然当代目标导致同时控制率持续较低，为 1.2%，但采用传统标准（血压 < 140/90 mmHg、HbA1c < 7%、LDL-c < 70 mg/dl）观察到显着改善，从 14.6% 增加到 33.7 %。在随访期间，死亡率为每 1000 患者年 24.4 起事件，仅发生在早期新诊断糖尿病的患者中。改善加班控制（而非基线）与较低的死亡率相关。相反，年龄 >75 岁 (HR = 2.6) 和 CKD (HR = 4.9) 与死亡率增加相关。结论。这些发现表明，在管理高血压和新诊断的糖尿病方面存在现实困难，特别是在新指南的严格标准下。高风险特征、高死亡率和较差的同步控制需要更积极的心肾保护，更多地关注患有早期新诊断糖尿病的老年 CKD 患者。