Blood pressure level associated with lowest cardiovascular event in hypertensive diabetic patients

Area of Science:

• Cardiology
• Endocrinology
• Public Health

Background:

• The ACCORD BP trial did not demonstrate benefits of strict blood pressure (BP) control on cardiovascular events in high-risk diabetic patients.
• This study investigates if lower mean BP in diabetic individuals with hypertension is associated with improved prognosis.

Purpose of the Study:

• To examine the association between mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and cardiovascular outcomes in diabetic patients with hypertension.
• To determine optimal BP targets for reducing mortality and cardiovascular events in this population.

Main Methods:

• Analysis of 7926 participants from the Korea National Health Insurance Service Health Examinee Cohort diagnosed with diabetes and hypertension (2003-2006).
• Comparison of mortality and cardiovascular events across groups based on mean SBP (<130, 130-<140, ≥140 mmHg) and mean DBP (<80, 80-<90, ≥90 mmHg) over up to 11 years of follow-up.

Main Results:

• A mean SBP of 130-<140 mmHg was associated with significantly reduced risks of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and end-stage renal disease compared to SBP ≥140 mmHg.
• A mean DBP of 80-<90 mmHg correlated with lower risks of all-cause death, cardiovascular mortality, and nonfatal strokes.
• A mean DBP <80 mmHg further reduced risks of all-cause mortality, cardiovascular mortality, ischemic stroke, and total stroke.

Conclusions:

• A mean blood pressure below 140/80 mmHg is associated with reduced risks of all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular events in diabetic hypertensive patients.
• These findings suggest a potential benefit of targeting BP below 140/80 mmHg in this patient group, contrasting with some previous trial outcomes.