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Systolic Blood Pressure and Cardiovascular Risk in Patients With Diabetes: A Prospective Cohort Study

Shishir Rao1,2, Yikuan Li1,2, Milad Nazarzadeh1,2

  • 1Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom (S.R., Y.L., M.N., M.M., G.S.-K., K.R.).

Hypertension (Dallas, Tex. : 1979)
|December 30, 2022
PubMed

Insights

Systolic blood pressure (SBP) and cardiovascular disease risk in diabetes patients show a monotonic relationship. Lower SBP levels are associated with the lowest cardiovascular event risk, refuting a J-shaped curve.

Area of Science:

  • Cardiology
  • Diabetology
  • Public Health

Background:

  • Controversy exists regarding the relationship between systolic blood pressure (SBP) and cardiovascular disease (CVD) risk, specifically if it's monotonic or has an optimal blood pressure nadir.
  • Investigating this association across the full spectrum of SBP in diabetic patients is crucial for understanding CVD risk stratification.

Purpose of the Study:

  • To investigate the association between systolic blood pressure (SBP) and cardiovascular events in patients with diabetes.
  • To determine if the relationship between SBP and cardiovascular outcomes is monotonic or exhibits a J-shaped curve.

Main Methods:

  • A cohort of 49,000 individuals with diabetes (aged 50-90) was identified from UK electronic health records (1990-2005).
  • Deep learning was employed to analyze associations between SBP and cardiovascular outcomes (ischemic heart disease, heart failure, stroke, cardiovascular death).

Main Results:

  • Over 7.3 years median follow-up, 16,378 cardiovascular events occurred.
  • A monotonic relationship was observed between SBP and cardiovascular events.
  • The lowest risk was in patients with baseline SBP <120 mm Hg; higher SBP levels showed incrementally increased adjusted risk ratios for CVD.

Conclusions:

  • Deep learning modeling confirmed a monotonic relationship between SBP and cardiovascular outcomes in patients with diabetes.
  • No evidence of a J-shaped relationship was found, indicating that lower SBP is consistently associated with lower CVD risk in this population.
Abstract

Keywords:
blood pressurecardiovascular diseasescausalitydiabetes mellitusmachine learning

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