Blood pressure and stroke risk among diabetic patients

Abstract

Context: Blood pressure (BP) control can reduce the risk of stroke among diabetic patients; however, it is not known whether the lowest risk of stroke is among diabetic patients with the lowest BP level. Objective: Our objective was to investigate the race-specific association of different levels of BP with stroke risk among diabetic patients in the Louisiana State University Hospital-based longitudinal study. Design, Setting, and Participants: We prospectively investigated the race-specific association of different levels of BP at baseline and during an average of 6.7 years of follow-up with incident stroke riskamong17 536 African American and 12 618 white diabetic patients within the Louisiana State University Hospital System. Main Outcome Measure: We evaluated incident stroke until May 31, 2012. Results: During follow-up, 2949 incident cases of stroke were identified. The multivariable-A djusted hazard ratios of stroke associated with different levels of systolic/diastolic BP at baseline (110/65, 110-119/65-69, 120-129/70-80 [reference group], 130-139/80-90, 140-159/90-100, and160/100mmHg) were 1.88(95%confidence interval1.38-2.56), 1.05 (0.80 -1.42), 1.00, 1.05 (0.86 -1.27), 1.12 (0.94 -1.34), and 1.47 (1.24 -1.75) for African American diabetic patients and 1.42 (1.06 -1.91), 1.22 (0.95-1.57), 1.00, 0.88 (0.72-1.06), 1.02 (0.86 -1.21), and 1.28 (1.07-1.54) for white diabetic patients, respectively.AU-shaped association of isolated systolic or diastolic BP at baseline and during follow-up with stroke risk was observed among both African American and white diabetic patients. The U-shaped association was confirmed in both patientswhowere and were n t taking antihypertensive drugs. Conclusions: The current study suggests a U-shaped association between BP and the risk of stroke. Aggressive BP control (110/65 mm Hg) and high BP (160/100 mm Hg) are associated with an increased risk of stroke among both African American and white patients with type 2 diabetes. Copyright © 2013 by The Endocrine Society.