Highlights
- High systolic blood pressure is linked to higher cardiovascular mortality in T2DM
- Similarly, very low diastolic blood pressure increases the risk of cardiovascular mortality with diabetes.
Actual systolic and diastolic blood pressure levels and cardiovascular mortality in patients with type 2 diabetes: results from a large registry cohort in Asia Summary Actual systolic and diastolic blood pressure levels and cardiovascular mortality in patients with type 2 diabetes: results from a large registry cohort in Asia Background Elevated blood pressure (BP) is associated with an increased risk of cardiovascular mortality. However, there is an ongoing debate about whether intensive blood pressure lowering may paradoxically increase the risk of cardiovascular disease (CVD), especially in patients with type 2 diabetes (T2D). We investigated the association of BP with the risk of CVD mortality in patients with type 2 diabetes. Methods and results We used data from 83,721 patients with type 2 diabetes from a multi-institutional diabetes registry in Singapore from 2013 to 2019. BP was analyzed as categories and restricted cubic splines using multivariable Cox regression analysis stratified by pre-existing CVD and age (<65 years versus ≥65 years). The primary outcome was CVD mortality, determined by linkage with the national registry. Among 83,721 patients with type 2 diabetes (mean age 65.3 years, 50.6% women, 78.9% taking antihypertensive medications), 7.6 per 1000 person-years experienced the primary outcome. Systolic blood pressure had a graded relationship with a significant increase in CVD mortality at levels >120 to 129 mm Hg. Diastolic BP levels >90 mm Hg were significantly associated with CVD mortality in people aged ≥65 years. Furthermore, diastolic BP <70 mm Hg was associated with a significantly increased risk of CVD mortality in all patients. Conclusions In patients with type 2 diabetes, clinical systolic BP levels ≥130 mm Hg or diastolic BP levels ≥90 mm Hg are associated with an increased risk of CVD mortality. Diastolic blood pressure <70 mm Hg is also associated with the risk of adverse CVD outcomes, although reverse causality cannot be ruled out. |
Figure. Hazard ratio (95% CI) for cardiovascular disease (CVD) mortality by systolic blood pressure (SBP) and diastolic blood pressure (DBP) categories. Analyzes were adjusted for cardiovascular disease comorbidity status, age, sex, antihypertensive medications, and DBP (main predictor is SBP)/SBP (main predictor is DBP). A and B, Stratification by CVD comorbidity subgroup. C and D, Stratification by age group.
Comments
Clinic systolic blood pressure (BP) ≥130 mm Hg or diastolic BP levels ≥90 mm Hg are associated with increased risk of cardiovascular disease (CVD) mortality in people with type 2 diabetes mellitus (T2DM), study finds published in the Journal of the American Heart Association .
Loraine Liping Seng, Ph.D., from Duke-NUS Medical School in Singapore, and colleagues investigated the association between BP and the risk of CVD mortality in patients with T2DM. The analysis included 83,721 patients with DM2 (2013 to 2019).
The researchers found that among patients, 7.6 per 1,000 person-years experienced CVD mortality. A graded relationship was observed between systolic BP and increased CVD mortality at levels >120 to 129 mm Hg. There was a significant association between diastolic BP levels >90 mm Hg and CVD mortality in people aged 65 years or older. Diastolic blood pressure <70 mm Hg was associated with a significantly increased risk of CVD mortality in all patients with T2DM.
"Our analysis underscores the need to control elevated systolic blood pressure to less than 130 mm Hg in patients with diabetes, while carefully evaluating the risks if diastolic pressure falls too low," he said in a statement.
What’s new?
Asian populations are at particularly high risk for type 2 diabetes, but the relationship between blood pressure and cardiovascular disease mortality remains unclear in this population.
Our analysis of a large sample of 83,721 patients with type 2 diabetes in a Singapore diabetes registry showed that the risk of cardiovascular disease mortality was lowest when systolic blood pressure levels of 120 to 129,000 mmHg were achieved and it was consistently observed that was higher with systolic blood pressure at levels ≥130 mm Hg in patients ≥65 years as well as in those <65 years.
Achieved diastolic blood pressure > 90 mmHg was associated with increased cardiovascular disease mortality in older patients with type 2 diabetes, and diastolic blood pressure <70 mmHg was associated with increased risk of cardiovascular disease mortality in all patients with diabetes. type 2.
What are the clinical implications?
Our findings support the reduction of systolic blood pressure levels to <130 mm Hg and diastolic blood pressure levels to <90 mm Hg in patients with type 2 diabetes. Use caution and evaluate patients with diastolic blood pressure levels < 70 mmHg.
