Real‐World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes—Results From a Large Registry Cohort in Asia
BACKGROUND Elevated blood pressure (BP) is associated with increased risk of cardiovascular mortality. However, there is ongoing debate whether intensive BP lowering may paradoxically increase the risk of cardiovascular disease (CVD), especially in patients with type 2 diabetes (T2D). We investigate...
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| Format: | Article |
| Language: | English |
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Wiley
2023-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.030772 |
| _version_ | 1797403651304587264 |
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| author | Loraine Liping Seng Troy Puar Hai Kiat Yong Mong Bee Tazeen H. Jafar |
| author_facet | Loraine Liping Seng Troy Puar Hai Kiat Yong Mong Bee Tazeen H. Jafar |
| author_sort | Loraine Liping Seng |
| collection | DOAJ |
| description | BACKGROUND Elevated blood pressure (BP) is associated with increased risk of cardiovascular mortality. However, there is ongoing debate whether intensive BP lowering may paradoxically increase the risk of cardiovascular disease (CVD), especially in patients with type 2 diabetes (T2D). We investigated the association of BP with risk of CVD mortality in patients with T2D. METHODS AND RESULTS We used data on 83 721 patients with T2D from a multi‐institutional diabetes registry in Singapore from 2013 to 2019. BP was analyzed as categories and restricted cubic splines using Cox multivariable regression analysis stratified by preexisting CVD and age (<65 years versus ≥65 years). The primary outcome was CVD mortality, determined via linkage with the national registry. Among 83 721 patients with T2D (mean age 65.3 years, 50.6% women, 78.9% taking antihypertensive medications), 7.6 per 1000 person‐years experienced the primary outcome. Systolic BP had a graded relationship with a significant increase in CVD mortality at levels >120 to 129 mm Hg. Diastolic BP levels >90 mm Hg were significantly associated with CVD mortality in those aged ≥65 years. In addition, diastolic BP <70 mm Hg was associated with a significantly higher risk of CVD mortality in all patients. CONCLUSIONS In patients with T2D, clinic systolic BP levels ≥130 mm Hg or diastolic BP levels ≥90 mm Hg are associated with higher risk of CVD mortality. Diastolic BP <70 mm Hg is also associated with the risk of adverse CVD outcomes, although reverse causality cannot be ruled out. |
| first_indexed | 2024-03-09T02:42:28Z |
| format | Article |
| id | doaj.art-93485aa89820431d8719a28ae7eacd45 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-09T02:42:28Z |
| publishDate | 2023-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-93485aa89820431d8719a28ae7eacd452023-12-06T02:49:39ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-12-01122310.1161/JAHA.123.030772Real‐World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes—Results From a Large Registry Cohort in AsiaLoraine Liping Seng0Troy Puar Hai Kiat1Yong Mong Bee2Tazeen H. Jafar3Program in Health Services and Systems Research Duke‐NUS Medical School SingaporeDepartment of Endocrinology Changi General Hospital SingaporeDepartment of Endocrinology Singapore General Hospital SingaporeProgram in Health Services and Systems Research Duke‐NUS Medical School SingaporeBACKGROUND Elevated blood pressure (BP) is associated with increased risk of cardiovascular mortality. However, there is ongoing debate whether intensive BP lowering may paradoxically increase the risk of cardiovascular disease (CVD), especially in patients with type 2 diabetes (T2D). We investigated the association of BP with risk of CVD mortality in patients with T2D. METHODS AND RESULTS We used data on 83 721 patients with T2D from a multi‐institutional diabetes registry in Singapore from 2013 to 2019. BP was analyzed as categories and restricted cubic splines using Cox multivariable regression analysis stratified by preexisting CVD and age (<65 years versus ≥65 years). The primary outcome was CVD mortality, determined via linkage with the national registry. Among 83 721 patients with T2D (mean age 65.3 years, 50.6% women, 78.9% taking antihypertensive medications), 7.6 per 1000 person‐years experienced the primary outcome. Systolic BP had a graded relationship with a significant increase in CVD mortality at levels >120 to 129 mm Hg. Diastolic BP levels >90 mm Hg were significantly associated with CVD mortality in those aged ≥65 years. In addition, diastolic BP <70 mm Hg was associated with a significantly higher risk of CVD mortality in all patients. CONCLUSIONS In patients with T2D, clinic systolic BP levels ≥130 mm Hg or diastolic BP levels ≥90 mm Hg are associated with higher risk of CVD mortality. Diastolic BP <70 mm Hg is also associated with the risk of adverse CVD outcomes, although reverse causality cannot be ruled out.https://www.ahajournals.org/doi/10.1161/JAHA.123.030772cardiovascular diseasediabetesdiastolic blood pressuremortalitysystolic blood pressure |
| spellingShingle | Loraine Liping Seng Troy Puar Hai Kiat Yong Mong Bee Tazeen H. Jafar Real‐World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes—Results From a Large Registry Cohort in Asia Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiovascular disease diabetes diastolic blood pressure mortality systolic blood pressure |
| title | Real‐World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes—Results From a Large Registry Cohort in Asia |
| title_full | Real‐World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes—Results From a Large Registry Cohort in Asia |
| title_fullStr | Real‐World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes—Results From a Large Registry Cohort in Asia |
| title_full_unstemmed | Real‐World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes—Results From a Large Registry Cohort in Asia |
| title_short | Real‐World Systolic and Diastolic Blood Pressure Levels and Cardiovascular Mortality in Patients With Type 2 Diabetes—Results From a Large Registry Cohort in Asia |
| title_sort | real world systolic and diastolic blood pressure levels and cardiovascular mortality in patients with type 2 diabetes results from a large registry cohort in asia |
| topic | cardiovascular disease diabetes diastolic blood pressure mortality systolic blood pressure |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.030772 |
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