Blood pressure lower than recommended level is beneficial in type 2 diabetes

Individuals with type 2 diabetes with blood pressure lower than currently recommended had a lower risk of CVD.
Individuals with type 2 diabetes with blood pressure lower than currently recommended had a lower risk of CVD.

Systolic blood pressure lower than 140 mm Hg is associated with a lower risk of cardiovascular events in patients with type 2 diabetes, according to data published in BMJ.

Samuel A  Eryd, PhD, from the Center of Registers Västra Götaland, University of Gotenburg, and Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues conducted  a population-based cohort study that included 187,106 patients with type 2 diabetes who were registered in the Swedish national diabetes register. The researchers sought to compare cardiovascular risk among individuals with blood pressure levels that meet current recommendations with the risk in individuals with lower blood pressure levels.

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“Recent hypertension guidelines have raised the target blood pressure for patients with diabetes from below 130 mm Hg to below 140 mm Hg because of a lack of conclusive randomized studies to support the lower goal, together with observational studies showing a J shaped relation between blood pressure and complications,” the study authors wrote.

The patients were younger than age 75 years and had no previous cardiovascular disease. The investigators used hospital discharge and death registers to obtain data regarding clinical events, including acute myocardial infarction, stroke, cardiovascular disease, coronary heart disease, heart failure, and total mortality.

Compared with patients with systolic blood pressure between 130 mm Hg and 139 mm Hg, patients with blood pressure between 110 mm Hg and 119 mm Hg had a significantly lower risk of non-fatal acute myocardial infarction (adjusted hazard ratio [HR]: 0.76) total acute myocardial infarction (HR: 0.85), non-fatal cardiovascular disease (HR: 0.82), total cardiovascular disease (HR: 0.88) and non-fatal coronary heart disease (HR: 0.88).

The researchers also noted that there was no indication of a J-shaped association between blood pressure and the clinical events, with the exception of heart failure and total mortality.

“The association between low blood pressure and increased mortality could be caused by concomitant disease rather than antihypertensive treatment,” they stated.

Reference

  1. Eryd SA, Gudbjornsdottir S, Manhem K, et al. Blood pressure and complications in individuals with type 2 diabetes and no previous cardiovascular disease: national population based cohort study. BMJ. 2016;354(4070). doi: 10.1136/bmj.i4070.
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