Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study
Background: Controversy persists about the relationship of blood pressure with cardiovascular diseases (CVD) in diabetes and associated disease burden. We assessed these associations among Chinese adults with type 2 diabetes (T2D). Methods: In 2004–08, the China Kadoorie Biobank recruited >512,00...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-02-01
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| Series: | The Lancet Regional Health. Western Pacific |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606520300857 |
| _version_ | 1798014708943421440 |
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| author | Fiona Bragg Jim Halsey Yu Guo Hua Zhang Ling Yang Xiaohui Sun Pei Pei Yiping Chen Huaidong Du Canqing Yu Robert Clarke Jun Lv Junshi Chen Liming Li Zhengming Chen |
| author_facet | Fiona Bragg Jim Halsey Yu Guo Hua Zhang Ling Yang Xiaohui Sun Pei Pei Yiping Chen Huaidong Du Canqing Yu Robert Clarke Jun Lv Junshi Chen Liming Li Zhengming Chen |
| author_sort | Fiona Bragg |
| collection | DOAJ |
| description | Background: Controversy persists about the relationship of blood pressure with cardiovascular diseases (CVD) in diabetes and associated disease burden. We assessed these associations among Chinese adults with type 2 diabetes (T2D). Methods: In 2004–08, the China Kadoorie Biobank recruited >512,000 adults aged 30–79 years from 10 localities across China, including 26,315 with T2D (based on self-report or plasma glucose measurement) but no prior CVD, followed-up for ~9 years. Cox regression yielded adjusted HR for major CVD and all-cause mortality associated with 10 mmHg higher usual (longer-term average) SBP. Attributable fractions were estimated to assess cardiovascular mortality burden due to uncontrolled hypertension (SBP ≥130 mmHg or DBP ≥80 mmHg). Findings: Overall, 75.7% of participants had self-reported (24.8%) or screen-detected (50.9%) (SBP ≥130 mmHg or DBP ≥80 mmHg) hypertension. Among individuals with self-reported hypertension, 82.3% were treated, of whom 9.3% achieved control. There were positive log-linear associations of blood pressure with CVD, with no evidence of a threshold down to ~120 mmHg for usual SBP. Each 10 mmHg higher usual SBP was associated with HR of 1.28 (95% CI 1.25–1.30), 1.18 (1.15–1.21), 1.17 (1.15–1.19) and 1.45 (1.38–1.52) for cardiovascular death (n=1807), major coronary event (n=1190), ischaemic stroke (n=4362) and intracerebral haemorrhage (n=469), respectively. There was an apparent J-shaped association with all-cause mortality (n=4503). In this diabetes population, uncontrolled hypertension accounted for 39% of cardiovascular deaths. Interpretation: Uncontrolled hypertension is common in Chinese adults with T2D, resulting in substantial excess risks of CVD. Improved hypertension management could avoid a large number of cardiovascular-related deaths. Funding: Kadoorie Foundation, Wellcome Trust, MRC, BHF, CR-UK, MoST, NNSF. |
| first_indexed | 2024-04-11T15:22:38Z |
| format | Article |
| id | doaj.art-9bc45c0ce5a044e8977d89ceb768aa90 |
| institution | Directory Open Access Journal |
| issn | 2666-6065 |
| language | English |
| last_indexed | 2024-04-11T15:22:38Z |
| publishDate | 2021-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj.art-9bc45c0ce5a044e8977d89ceb768aa902022-12-22T04:16:20ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652021-02-017100085Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort studyFiona Bragg0Jim Halsey1Yu Guo2Hua Zhang3Ling Yang4Xiaohui Sun5Pei Pei6Yiping Chen7Huaidong Du8Canqing Yu9Robert Clarke10Jun Lv11Junshi Chen12Liming Li13Zhengming Chen14Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK; Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK; Corresponding authors at: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK.Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK; Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UKChinese Academy of Medical Sciences, Beijing 102308, ChinaQingdao Center for Disease Control and Prevention, 175 Shandong Road, Qingdao 266033, ChinaClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK; Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UKQingdao Center for Disease Control and Prevention, 175 Shandong Road, Qingdao 266033, ChinaChinese Academy of Medical Sciences, Beijing 102308, ChinaClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK; Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UKClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK; Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UKSchool of Public Health, Peking University Health Science Center, Beijing, ChinaClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UKSchool of Public Health, Peking University Health Science Center, Beijing, ChinaChina National Center For Food Safety Risk Assessment, Beijing 100022, ChinaSchool of Public Health, Peking University Health Science Center, Beijing, ChinaClinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK; Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK; Corresponding authors at: Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK.Background: Controversy persists about the relationship of blood pressure with cardiovascular diseases (CVD) in diabetes and associated disease burden. We assessed these associations among Chinese adults with type 2 diabetes (T2D). Methods: In 2004–08, the China Kadoorie Biobank recruited >512,000 adults aged 30–79 years from 10 localities across China, including 26,315 with T2D (based on self-report or plasma glucose measurement) but no prior CVD, followed-up for ~9 years. Cox regression yielded adjusted HR for major CVD and all-cause mortality associated with 10 mmHg higher usual (longer-term average) SBP. Attributable fractions were estimated to assess cardiovascular mortality burden due to uncontrolled hypertension (SBP ≥130 mmHg or DBP ≥80 mmHg). Findings: Overall, 75.7% of participants had self-reported (24.8%) or screen-detected (50.9%) (SBP ≥130 mmHg or DBP ≥80 mmHg) hypertension. Among individuals with self-reported hypertension, 82.3% were treated, of whom 9.3% achieved control. There were positive log-linear associations of blood pressure with CVD, with no evidence of a threshold down to ~120 mmHg for usual SBP. Each 10 mmHg higher usual SBP was associated with HR of 1.28 (95% CI 1.25–1.30), 1.18 (1.15–1.21), 1.17 (1.15–1.19) and 1.45 (1.38–1.52) for cardiovascular death (n=1807), major coronary event (n=1190), ischaemic stroke (n=4362) and intracerebral haemorrhage (n=469), respectively. There was an apparent J-shaped association with all-cause mortality (n=4503). In this diabetes population, uncontrolled hypertension accounted for 39% of cardiovascular deaths. Interpretation: Uncontrolled hypertension is common in Chinese adults with T2D, resulting in substantial excess risks of CVD. Improved hypertension management could avoid a large number of cardiovascular-related deaths. Funding: Kadoorie Foundation, Wellcome Trust, MRC, BHF, CR-UK, MoST, NNSF.http://www.sciencedirect.com/science/article/pii/S2666606520300857Blood pressureCardiovascular diseaseChinaDiabetesHypertensionIschaemic heart disease |
| spellingShingle | Fiona Bragg Jim Halsey Yu Guo Hua Zhang Ling Yang Xiaohui Sun Pei Pei Yiping Chen Huaidong Du Canqing Yu Robert Clarke Jun Lv Junshi Chen Liming Li Zhengming Chen Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study The Lancet Regional Health. Western Pacific Blood pressure Cardiovascular disease China Diabetes Hypertension Ischaemic heart disease |
| title | Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study |
| title_full | Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study |
| title_fullStr | Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study |
| title_full_unstemmed | Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study |
| title_short | Blood pressure and cardiovascular diseases in Chinese adults with type 2 diabetes: A prospective cohort study |
| title_sort | blood pressure and cardiovascular diseases in chinese adults with type 2 diabetes a prospective cohort study |
| topic | Blood pressure Cardiovascular disease China Diabetes Hypertension Ischaemic heart disease |
| url | http://www.sciencedirect.com/science/article/pii/S2666606520300857 |
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