Objective: Blood pressure ranges associated with cardiovascular disease (CVD) events in advanced type 2 diabetes are not clear. Our objective was to determine whether baseline and follow-up (On-Study) systolic BP (SBP), diastolic BP (DBP), and SBP combined with DBP predict CVD events in the Veterans Affairs Diabetes Trial (VADT).

Research Design and Methods: Participants in the VADT (n=1791) with hypertension received stepped treatment to maintain BP below the target of 130/80 mmHg in standard and intensive glycemic treatment groups. BP levels of all subjects at baseline and On-Study were analyzed to detect associations with CVD risk. The primary outcome was the time from randomization to the first occurrence of myocardial infarction, stroke, congestive heart failure, surgery for vascular disease, inoperable coronary disease, amputation for ischemic gangrene or CVD death.

Results: Separated SBP≥140 mmHg had significant risk at baseline (HR=1.508 P<0.001) and On-Study (HR=1.469, P=0.002). DBP<70 mmHg increased CVD events at baseline (HR=1.482, P<0.001) and On-Study (HR=1.491, P<0.001). Combined blood pressure categories indicated high risk for CVD events for SBP≥140 with DBP<70 mmHg at baseline (HR=1.785, P=0.03) and On-Study (HR=2.042, P=0.003), and nearly all SBP with DBP<70 mmHg.

Conclusions: Increased risk of CVD events with SBP≥140 mmHg emphasizes the urgency for treatment of systolic hypertension. Increased risk with DBP<70 mmHg, even when combined with SBP in guideline-recommended target ranges, supports a new finding in patients with type 2 diabetes. The results emphasize that DBP<70 mmHg in these patients was associated with elevated CVD risk and may best be avoided.