Ideal Systolic Blood Pressure for CVD Prevention in Diabetes, Hypertension

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Incidence of all-cause mortality was significantly increased in groups with SBP <120 mmHg and SBP <130mmHg.
Incidence of all-cause mortality was significantly increased in groups with SBP <120 mmHg and SBP <130mmHg.

A systolic blood pressure (SBP) of 140 mmHg is the recommended target for reducing risk for cardiovascular disease (CVD) in individuals with coexisting hypertension and diabetes, according to a study recently published in Diabetes Care.

This retrospective, population-based cohort study included 28,014 patients with type 2 diabetes mellitus and no history of CVD. After an increase in their antihypertensive regimen, there were 2079 patients who had achieved a SBP of <120 mmHg, 10,851 who had achieved <130 mmHg, and 15,084 who had achieved <140 mmHg.

The study researchers classified patients for subgroup analyses according to baseline characteristics. They used Cox regressions to investigate correlations between SBP and CVD after a median follow-up duration of 4.8 years.

There were 318 incidents of CVD in patients who achieved SBP of <120 mmHg (15.3%; incidence rate [IR] 34.3/1000 person-years [PY]), 992 incidents in patients who achieved <130 mmHg (9.1%; IR 20.4/1000 PY), and 1635 incidents in patients who achieved <140 mmHg (10.8%; IR 21.4/1000 PY). Those who achieved <120 mmHg were 1.75 times more likely to have CVD than those who achieved <130 mmHg (95% CI, 1.53-2.00) and 1.67 more likely than those who achieved <140 mmHg (95% CI, 1.46-1.90).

Individuals ≤ 65 years who achieved SBP <130 mmHg were at significantly lower risk for CVD than those who achieved <140 mmHg (hazard ratio 0.81; 95% CI, 0.69-0.96), but there was no difference for other subgroups.

The study researchers conclude that these findings “support a SBP treatment target of 140 mmHg and suspect no risk reduction attenuation on CVD for lower SBP targets (<120 or <130 mmHg) for most patients with uncomplicated [type 2 diabetes]. A randomized control trial is still needed to confirm these findings.”

Reference

Wan EYF, Yu EYT, Chin WY, et al. Effect of achieved systolic blood pressure on cardiovascular outcomes in patients with type 2 diabetes mellitus: a population-based retrospective cohort study [published online March 28, 2018]. Diabetes Care. doi: 10.2337/dc17-2443

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