Effect of achieved systolic blood pressure on cardiovascular outcomes in patients with type 2 diabetes: A population-based retrospective cohort study

Abstract

The objective of this study was to compare the incidence of cardiovascular disease (CVD) amongpatientswithtype2diabetesmellitus (T2DM)withtreatedhypertension who achieved systolic blood pressures (SBPs) of <120, <130, and <140mmHg after an increase in their antihypertensive regimen. RESEARCH DESIGN AND METHODS A retrospective cohort study was conducted on 28,014 primary care adult patients withT2DMwithnopriordiagnosisofCVDandwhoachievedSBPreadings<140mmHg after an increase in the number of antihypertensivemedications prescribed. Using an extension of propensity score matching, a total of 2,079, 10,851, and 15,084matched patients with achieved SBP measurements of <120, <130, and <140 mmHg were identified. The association between achieved SBP and incident CVD were evaluated using Cox regressions. Subgroup analyses were conducted by stratifying patients' baseline characteristics. RESULTS Over a median follow-up period of 4.8 years, the incidence of CVD in patients with achieved SBP measures of <120, <130, and <140 mmHg were 318 (15.3%; incidence rate[IR]34.3/1,000person-years [PY]),992(9.1%; IR20.4/1,000PY),and1,635(10.8%; IR 21.4/1,000 PY). Achieved SBP <120mmHgwas associated with a higher risk of CVD comparedwith achieved SBP <130mmHg (hazard ratio [HR] 1.75 [95%CI 1.53, 2.00]) and achieved SBP <140 mmHg (HR 1.67 [95% CI 1.46, 1.90]). There was a significant reduction in CVD risk in patients <65 years (HR 0.81 [95% CI 0.69, 0.96]) but no differenceforotherpatients, includingpatients≥65years,whoachievedSBP<130mmHg when compared with the group that achieved SBP <140 mmHg. CONCLUSIONS Our findings support a SBP treatment target of 140 mmHg and suspect no risk reduction attenuation on CVD for lower SBP targets (<120 or <130 mmHg) for most patients with uncomplicated T2DM. A randomized control trial is still needed to confirm these findings.