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Clinical Summary

Lower Systolic BP Is Tied to a Lower Risk of Future Cardiovascular Disease

Takeaway

  • In patients with diabetes, those with low systolic blood pressure (BP; <120 mmHg) had a lower risk of future cardiovascular disease (CVD).

Why This Matters

  • Findings extend the lower, the better paradigm of BP management in patients with diabetes and provide reassurance about the role of intensive BP lowering in this growing patient population.

Study Design

  • This was a prospective cohort study that included 49,000 patients with diabetes (age 50-90 years), identified using data from the UK Clinical Practice Research Datalink (1990-2005).
  • Primary outcome: fatal or nonfatal CVD (composite of ischaemic heart disease, incident heart failure, stroke, and cardiovascular death).
  • Secondary outcomes: individual components of the primary outcome, such as incident heart failure and stroke.
  • Funding: British Heart Foundation and others.

Key Results

  • During a median follow-up of 7.3 years, 16,378 (33.4%) patients had cardiovascular events.
  • Compared with patients with low systolic BP (<120 mmHg), the risk of (adjusted risk ratio [aRR]; 95% CI):
    • fatal or nonfatal CVD was higher in those with systolic BP of:
      • 140-149 mmHg (1.08; 1.01 to 1.15);
      • 150-159 mmHg (1.12; 1.03 to 1.20); and
      • ≥160 mmHg (1.19; 1.09 to 1.28).
    • incident heart failure was higher in those with systolic BP of ≥160 mmHg (1.28; 1.08 to 1.48).
    • stroke was higher in those with systolic BP of:
      • 130-139 mmHg (1.17; 1.02 to 1.33);
      • 140-149 mmHg (1.23; 1.05 to 1.42);
      • 150-159 mmHg (1.24; 1.03 to 1.46); and
      • ≥160 mmHg (1.40; 1.19 to 1.61).

Limitations

  • Observational design.
  • Risk of unmeasured confounding.

References


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