Linear SBP link to stroke risk supports tighter targets in type 1 diabetes
medwireNews: A lower than currently recommended blood pressure target may be necessary to reduce the risk for stroke in people with type 1 diabetes, say researchers.
Per-Henrik Groop (University of Helsinki, Finland) and colleagues studied 4105 individuals with type 1 diabetes who were part of the observational FinnDiane Study and did not have stroke at baseline. Of these, 202 (5%) had a stroke during follow-up, with 72% having an ischemic and 28% a hemorrhagic stroke.
These people were older than those who did not have a stroke, with an average age of 45.8 versus 36.9 years; had higher blood pressure, at an average of 150 versus 133 mmHg for systolic blood pressure (SBP) and 83 versus 79 mmHg for diastolic blood pressure (DBP); and more often had hypertension, at 66% versus 32%.
As expected, baseline blood pressure was significantly associated with risk for stroke during follow-up, after accounting for variables such as sex, waist circumference, diabetes duration, glycated hemoglobin, antihypertensive medication, and coronary heart disease. Each 10 mmHg rise in SBP and DBP was associated with respective 20% and 21% increases in stroke risk, and there were also significant associations for mean arterial and pulse pressure.
“As in the general population, SBP seems to be a very strong risk factor for stroke also in type 1 diabetes,” write Groop and team in Cardiovascular Diabetology.
When the researchers modeled the shape of the associations, they found linear relationships between stroke risk and SBP, mean arterial pressure, and pulse pressure, whereas DBP was only associated with stroke risk at values over 80 mmHg.
“In individuals with type 2 diabetes, the risk of stroke increases after blood pressure exceeds 130/80 mmHg,” say the researchers. “In our study [of people with type 1 diabetes], the risk of stroke starts to increase at similar DBP levels, while for SBP, linear increase is observed even earlier.”
They point out that the current ADA guidelines stipulate a blood pressure target of 140/90 mmHg for most people with diabetes, and say their findings support American Heart Association advice to treat to a target of 130/80 mmHg in people with type 1 diabetes.
However, research reported at this year’s ADA Scientific Sessions suggested that an even lower target of 120/80 mmHg may be needed to prevent coronary artery disease in people with type 1 diabetes.
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