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Original Research
Effect of Achieved Systolic Blood Pressure on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus: A Population-Based Retrospective Cohort Study
Eric Yuk Fai Wan, Esther Yee Tak Yu, Weng Yee Chin, Colman Siu Cheung Fung, Daniel Yee Tak Fong, Edmond Pui Hang Choi, Anca Ka Chun Chan, Cindy Lo Kuen Lam
Diabetes Care 2018 Mar; dc172443. https://doi.org/10.2337/dc17-2443
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Abstract

OBJECTIVE The objective of this study was to compare the incidence of cardiovascular disease (CVD) among patients with type 2 diabetes mellitus (T2DM) with treated hypertension who achieved systolic blood pressures (SBPs) of <120, <130, and <140 mmHg after an increase in their antihypertensive regimen.

RESEARCH DESIGN AND METHODS A retrospective cohort study was conducted on 28,014 primary care adult patients with T2DM with no prior diagnosis of CVD and who achieved SBP readings <140 mmHg after an increase in the number of antihypertensive medications prescribed. Using an extension of propensity score matching, a total of 2,079, 10,851, and 15,084 matched 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] 34.3/1,000 person-years [PY]), 992 (9.1%; IR 20.4/1,000 PY), and 1,635 (10.8%; IR 21.4/1,000 PY). Achieved SBP <120 mmHg was associated with a higher risk of CVD compared with achieved SBP <130 mmHg (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 difference for other patients, including patients ≥65 years, who achieved SBP <130 mmHg 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.

Footnotes

  • This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc17-2443/-/DC1.

  • Received November 22, 2017.
  • Accepted March 4, 2018.
  • © 2018 by the American Diabetes Association.
http://www.diabetesjournals.org/content/license

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.

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Effect of Achieved Systolic Blood Pressure on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus: A Population-Based Retrospective Cohort Study
Eric Yuk Fai Wan, Esther Yee Tak Yu, Weng Yee Chin, Colman Siu Cheung Fung, Daniel Yee Tak Fong, Edmond Pui Hang Choi, Anca Ka Chun Chan, Cindy Lo Kuen Lam
Diabetes Care Mar 2018, dc172443; DOI: 10.2337/dc17-2443

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Effect of Achieved Systolic Blood Pressure on Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus: A Population-Based Retrospective Cohort Study
Eric Yuk Fai Wan, Esther Yee Tak Yu, Weng Yee Chin, Colman Siu Cheung Fung, Daniel Yee Tak Fong, Edmond Pui Hang Choi, Anca Ka Chun Chan, Cindy Lo Kuen Lam
Diabetes Care Mar 2018, dc172443; DOI: 10.2337/dc17-2443
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