Blood pressure extremes increase CVD event risk in diabetic patients
MedWire News: High systolic (S) and low diastolic (D) blood pressure (BP) increase the risk for cardiovascular disease (CVD) events in patients with Type 2 diabetes, report researchers from the Veterans Affairs Diabetes Trial (VADT).
Previous research has demonstrated the health benefits of lowering BP in both diabetic and nondiabetic patients with higher than normal values. However, specific SBP and DBP targets for preventing CVD events in diabetic patients have not been confirmed.
Robert Anderson (Veterans Affairs Medical Center, Omaha, Nebraska, USA) and colleagues therefore evaluated the CVD event risk of 1791 Type 2 diabetic participants of the VADT who received treatment for hypertension to achieve a BP below 130/80 mmHg.
BP levels of the participants were assessed at baseline, at a mean age of 60.4 years, and after 7 years of treatment. At baseline, the mean body mass index was 31 kg/m2 and average glycated hemoglobin was 9.4%.
The team found that having a SBP at or above 140 mmHg both at baseline and on-study increased the risk for CVD events (myocardial infarction, stroke, congestive heart failure, vascular surgery, coronary artery disease, amputation for ischemic gangrene, or CVD death) by a significant 51% and 47%, respectively, compared with lower levels.
Conversely, having a DBP below 70 mmHg at baseline and during the study was associated with corresponding significant increased risks of 48% and 49% for CVD events versus higher levels.
Having both a SBP at or above 140 mmHg and a DBP below 70 mmHg at baseline or during the study raised the risk further and resulted in increased risks for CVD events of 1.79- and 2.04-fold, respectively, compared with having a lower SBP and higher DBP.
"Our results raise awareness of the increased CVD risk of DBP below 70 mmHg with 105-129/70-79 mmHg as a reasonable BP target range for patients with Type 2 diabetes," write the authors in the journal Diabetes Care.
They add: "Future research questions include whether BP control changed outcomes for individual patients in higher-risk SBP or DBP categories. We also plan to investigate the potential associations of these high-risk BP categories with microvascular events."
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By Helen Albert