Blood pressure and cardiovascular outcomes in patients with diabetes and high cardiovascular risk.


eMediNexus Editorial    23 February 2018

A new study published in the European Heart Journal analyzed the association between blood pressure and cardiovascular (CV) outcomes in high-risk patients with type-2 diabetes mellitus (T2DM).

This study included patients with T2DM who were at high risk for developing cardiovascular disease.

The results revealed that the adjusted risk of the composite endpoint of CV death, myocardial infarction (MI) or ischemic stroke exhibited U-shaped relationships with baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) – their lowest points being: SBP 130-140 or DBP 80-90 mmHg. While, diastolic blood pressure <60 mmHg was associated with increased risk of myocardial infarction (MI) relative to DBP of 80-90 mmHg. Meanwhile, adjusted odds of high-sensitivity troponin-T (hsTnT) concentration ≥14 ng/L showed U-shaped relationships with SBP and DBP. Additionally, the relationships between low DBP, elevated hsTnT, and increased MI persisted after exclusion of patients with prior heart failure or N-terminal pro-B-type natriuretic peptide (NT-proBNP) >median, indicating that the relationship was not due to confounding from diagnosed or undiagnosed heart failure.

From the findings, it was inferred that in patients with diabetes and elevated CV risk, even after extensive adjustment for underlying disease burden, the association of low DBP with subclinical myocardial injury and risk of MI persists.

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