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Blood pressure and heart failure risk among diabetic patients
Wenhui Zhao1, Peter T Katzmarzyk2, Ronald Horswell2
1Pennington Biomedical Research Center, Baton Rouge, LA, USA; China Japan Friendship Hospital, Beijing, China.
Insights
Achieving the lowest blood pressure (BP) in diabetic patients does not necessarily mean the lowest risk of heart failure (HF). A U-shaped association indicates that both very low and high BP levels increase HF risk.
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Blood pressure (BP) control is crucial for reducing heart failure (HF) risk in diabetic individuals.
- The optimal BP target for minimizing HF risk in this population remains unclear.
Purpose of the Study:
- To investigate the association between different blood pressure (BP) levels and the risk of incident heart failure (HF) in diabetic patients.
- To determine if the lowest achieved BP correlates with the lowest HF risk.
Main Methods:
- A prospective cohort study involving 17,181 African American and 12,446 white diabetic patients without prior coronary heart disease or HF.
- Cox proportional hazards regression models were employed to analyze BP stratification and incident HF risk.
Main Results:
- Over a mean follow-up of 6.5 years, 5,089 incident HF cases were recorded.
- A U-shaped association was observed between BP levels and HF risk, with both very low (<110/65 mmHg) and high (≥140/90 mmHg) BP associated with increased risk compared to the reference group (130-139/80-90 mmHg).
- This association persisted across different treatment statuses and HF subtypes (systolic and preserved ejection fraction).
Conclusions:
- The study suggests a U-shaped relationship between observed blood pressure and heart failure risk in diabetic patients.
- Neither extremely low nor high blood pressure is optimal for reducing heart failure incidence in this population.
Background:
Blood pressure (BP) control has been shown to reduce the risk of heart failure (HF) among diabetic patients; however, it is not known whether the lowest clinical BP achieved ultimately results in the lowest risk of HF in diabetic patients.
Methods:
We performed a prospective cohort study which included 17,181 African American and 12,446 white diabetic patients without established coronary heart disease and HF at diabetes diagnosis. Cox proportional hazards regression models were used to estimate the association of different levels of BP stratification with incident HF.
Results:
During a mean follow up of 6.5 years, 5,089 incident HF cases were identified. The multivariable-adjusted hazard ratios of HF associated with different levels of systolic/diastolic BP (<110/65, 110-119/65-69, 120-129/70-80, 130-139/80-90 [reference group], 140-159/90-100, and ≥ 160/100 mmHg) were 1.79 (95% confidence interval [CI] 1.53-2.11), 1.34 (95% CI 1.16-1.53), 1.02 (95% CI 0.92-1.13), 1.00, 1.04 (95% CI 0.95-1.12), and 1.26 (95% CI 1.16-1.37) using baseline BP measurements, and 2.63 (95% CI 2.02-3.41), 1.84 (95% CI 1.59-2.13), 1.25 (95% CI 1.14-1.37), 1.00, 1.11 (95% CI 1.03-1.19), and 1.32 (95% CI 1.20-1.44) using an updated mean value of BP during follow-up, respectively. The U-shaped association was confirmed in both patients who were and were not taking antihypertensive drugs, and in incident systolic HF (ejection fraction ≤ 40%) and incident HF with a preserved ejection fraction (ejection fraction >40%).
Conclusions:
The current study suggests a U-shaped association between observed BP and the risk of HF among diabetic patients.
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